Control of device including mechanical arms

ABSTRACT

A method of jointed device movement inside a body comprising: measuring movement of at least one input object portion; mapping the measured input object portion movement to a jointed device portion movement; and moving the device portion according to mapped measured movements.

RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.15/418,891, filed on Jan. 30, 2017, which is a continuation of PCTPatent Application No. PCT/IL2015/050891 having International filingdate of Sep. 4, 2015, which claims the benefit of priority under 35 USC§ 119(e) of U.S. Provisional Patent Application Nos. 62/045,756 and62/045,802 both filed on Sep. 4, 2014.

U.S. patent application Ser. No. 15/418,891, filed on Jan. 30, 2017, isalso a Continuation of PCT Patent Application No. PCT/IL2015/050892having International filing date of Sep. 4, 2015, which claims thebenefit of priority under 35 USC § 119(e) of U.S. Provisional PatentApplication Nos. 62/045,756 and 62/045,802 both filed on Sep. 4, 2014.

U.S. patent application Ser. No. 15/418,891, filed on Jan. 30, 2017, isalso a Continuation of PCT Patent Application No. PCT/IL2015/050893having International filing date of Sep. 4, 2015, which claims thebenefit of priority under 35 USC § 119(e) of U.S. Provisional PatentApplication Nos. 62/045,756 and 62/045,802 both filed on Sep. 4, 2014.

The contents of the above applications are all incorporated by referenceas if fully set forth herein in their entirety.

FIELD AND BACKGROUND OF THE INVENTION

The present invention, in some embodiments thereof, relates to of adevice including mechanical arms, more particularly, but notexclusively, to methods and apparatus for control of a surgical deviceincluding mechanical arms.

Background art includes: “Design of a Compact Robotic Manipulator forSingle-Port Laparoscopy” by Claudio Quaglia et al, Paper No: MD-13-1148in J. Mech. Des. 136(9), 095001 (Jun. 13, 2014); “An inverse kinematicsmethod for 3D figures with motion data” by Taku Komura et al,Proceedings of the Computer Graphics International (CGI'03);

Hubens et al., 2004, “What Have we Learnt after Two Years Working withthe Da Vinci Robot System in Digestive Surgery?”, Acta chir belg;

Michael Irvine, 2009, “Anaesthesia for Robot-Assisted LaparoscopicSurgery”, Cont Edu Anaesth Crit Care and Pain;

Jeong Rim Lee, 2014, “Anesthetic considerations for robotic surgery”,Korean Journal of Anesthesiology;

Teljeur et al., 2014, “Economic evaluation of robot-assistedhysterectomy: a cost-minimisation analysis”, BJOG;

Box et al., 2008, “Rapid communication: robot-assisted NOTESnephrectomy: initial report”, J Endourol;

DR. Domigo, 2009, “Overview of current hysterectomy trends”, ExpertReview of Obstetrics & Gynecology; and

DR. Kho, “Vaginal versus laparoscopic hysterectomy”, Contemporary OB/GYNExpert Advice, 2013.

Additional background art includes U.S. Pat. No. 8,224,485, U.S. Pat.No. 8,347,754, U.S. Pat. No. 7,833,156, U.S. Pat. No. 8,518,024,International Patent Application Publication No. WO 2010096580, andInternational Patent Application Publication No. WO 2013116869.

SUMMARY OF THE INVENTION

According to an aspect of some embodiments of the present inventionthere is provided a surgical system comprising:

a surgical device sized and shaped for insertion into a human bodycomprising at least one articulated limb, which limb comprises aplurality of sequentially coupled surgical device portions;

an input device, comprising at least one articulated limb, which limbcomprises a plurality of sequentially coupled input device portions; and

a controller which controls movement of one or more portion of thesurgical device articulated limb;

wherein at least one portion of the input device limb corresponds to oneor more portions of the surgical device limb;

wherein the controller controls movement of the one or more portions ofthe device limb based on movement of the at least one portion of theinput device limb.

According to some embodiments of the invention, the system includessequentially coupled independently bendable and rotatable flexibleportions.

According to some embodiments of the invention, the input device limbincludes sequentially coupled independently bendable and rotatablesegments.

According to some embodiments of the invention, the flexible portionsare coupled by segments.

According to some embodiments of the invention, the input devicecomprises segments coupled by joints; wherein each the input devicejoint corresponds to a surgical device flexible portion.

According to some embodiments of the invention, an angle at an inputdevice joint controls an angle of a corresponding surgical deviceflexible portion.

According to some embodiments of the invention, the input devicecomprises segments coupled by joints;

wherein an angle between sequentially coupled segments controls an angleof flexion of a corresponding surgical device flexible portion.

According to some embodiments of the invention, the input devicecomprises:

-   -   an input device support segment;    -   a first segment;    -   a second segment;    -   a first joint coupling the first segment to the support segment;        and    -   a second joint coupling the second segment to the first segment.

According to some embodiments of the invention, the surgical device limbcomprises:

a surgical device support segment;

a first flexible section extending from the support segment andterminating in a coupling section; and

a second flexible section extending from the coupling section andterminating in a tool or a connector for a tool.

According to some embodiments of the invention, the input device supportsegment corresponds to the surgical device support segment;

wherein the first joint corresponds to the first flexible section;

wherein the second joint corresponds to the second flexible section.

According to some embodiments of the invention, at least one ratiobetween long axis lengths of input device segments is about acorresponding ratio of effective long axis lengths of surgical devicesegments.

According to some embodiments of the invention, at least one ratiobetween long axis lengths of surgical device effective segments is aboutthat of a length ratio for corresponding human limb segments.

According to some embodiments of the invention, the system comprises twoinput device limbs corresponding to two surgical device limbs. Accordingto some embodiments of the invention, the surgical device comprises atool coupled to a distal end of the surgical device limb. According tosome embodiments of the invention, actuation of the tool is controlledby one or more user interface on the input device.

According to some embodiments of the invention, the input deviceincludes a handle coupled to a portion of the input device which extendsaway from the input device limb. According to some embodiments of theinvention, the handle includes an extendable portion, extension thereofincreasing a separation of at least one part of the handle from theinput device.

According to some embodiments of the invention, the input deviceincludes one or more locking mechanism; wherein the locking mechanism,when in a locked configuration, reduces movement of at least one of theinput device portions with respect to one or more of the input deviceportions.

According to some embodiments of the invention, the coupling of theinput device portions is low enough friction such that moving a portionof the input device causes movement of portions coupled proximally tothe input device being moved.

According to some embodiments of the invention, the surgical devicecomprises more limbs controllable by the controller than the inputdevice.

-   -   According to an aspect of some embodiments of the present        invention there is provided an input device for control of a        surgical device comprising:    -   at least one articulated limb which limb comprises a plurality        of sequentially coupled portions;    -   at least one sensor configured to generate an indication of a        relative position of at least a portion of the articulated limb        with respect to another portion of the articulated limb;    -   a processor configured to generate, from the sensed positions,        motor control signals, for control of a surgical device.

According to some embodiments of the invention, the limb comprises:

-   -   a support segment;    -   a first segment;    -   a second segment;    -   a first joint coupling the first segment to the support segment;        and    -   a second joint coupling the second segment to the first segment.

According to some embodiments of the invention, one or more of thejoints are rotational joints enabling rotation of segments coupled tothe joints to rotate about segment long axes.

According to some embodiments of the invention, each first segment isbendable in a single bending plane about the first joint;

wherein each second segment is bendable in a single bending plane aboutthe second joint.

According to some embodiments of the invention, the at least one sensoris a motion sensor attached to the articulated limb.

According to some embodiments of the invention, one or more sensormeasures: rotation of one or more portion about a portion long axis; and

-   -   one or more angle between coupled portions.

According to some embodiments of the invention, the device comprises agear coupled to a portion of the input device; and a sensor which sensesrotation of the gear.

According to some embodiments of the invention, the input deviceincludes a handle coupled to a portion of the input device which extendsaway from the input device limb. According to some embodiments of theinvention, the handle includes an extendable portion, extension thereofincreasing a separation of at least one part of the handle from theinput device.

According to some embodiments of the invention, the sensor is a camera.

According to an aspect of some embodiments of the present inventionthere is provided a method of jointed device movement inside a bodycomprising:

-   -   measuring movement of at least one input object portion;    -   mapping the measured input object portion movement to a jointed        device portion movement;    -   moving the device portion according to mapped measured        movements.

According to some embodiments of the invention, the jointed devicecomprises a first device limb and a second device limb;

wherein the input object comprises a first input object limb and asecond input object limb;

wherein measuring comprises measuring movement of one or more portion ofthe first input object limb and one or more portion of the second inputobject limb simultaneously;

wherein mapping comprises:

-   -   mapping the measured movements of the portion of the first input        object limb to a corresponding portion of the first device limb;        and    -   mapping the measured movements of the portion of the second        input device limb to a corresponding portion of the second        device limb;

wherein moving comprises moving simultaneously the device limbsaccording to the mapped movements.

According to some embodiments of the invention, the method comprises

initializing an input object limb by moving the input object limb into aconfiguration corresponding to a configuration of a device limb.

According to some embodiments of the invention, the input object is atleast a portion of a user body.

According to some embodiments of the invention, mapping comprises:matching one or more input device portion to a corresponding surgicaldevice portion; and scaling the measured movement.

According to some embodiments of the invention, the surgical deviceportion is an end effecter. According to some embodiments of theinvention, the input object portion is a user body joint.

According to some embodiments of the invention, moving comprises movingsimultaneously moving more than one device joint according to the mappedmovements.

According to some embodiments of the invention, measuring comprises:repetitively capturing images of the user first limb and the user secondlimb; and processing the images to extract the movements of the userfirst limb and the user second limb. According to some embodiments ofthe invention, measuring comprises: filtering the measured movement ofthe user limb joints.

According to some embodiments of the invention, filtering comprisesremoving large movements. According to some embodiments of theinvention, filtering comprises removing tremors. According to someembodiments of the invention, filtering comprises removing movementsinto a disallowed region.

According to some embodiments of the invention, the method comprises:selecting the input object portion; and selecting the device portion.

According to some embodiments of the invention, the input object portionis an input object limb; wherein the device portion is a device limb.

According to some embodiments of the invention, measuring comprisesmeasuring movement of more than one portion of the input object limb;wherein the mapping comprises mapping measured movement of each theportion of the input object limb to movement of a portion of the jointeddevice limb. According to some embodiments of the invention, measuringcomprises measuring finger movements of at least one user hand; whereinthe mapping comprises mapping the measured finger movements to a devicelimb tool; wherein the moving comprises moving the device tool accordingto the mapped finger movements.

According to an aspect of some embodiments of the present inventionthere is provided an input device for control of a surgical devicecomprising:

at least one articulated limb which limb comprises a plurality ofsequentially coupled portions;

a plurality of locking mechanisms each locking mechanism for preventingrelative movement of between two sequentially coupled portions;

at least one sensor providing a signal relating to a level of contact ofa user with the input device;

a processor configured to:

-   -   detect from the signal an insufficient level of contact;    -   send, upon detection of an insufficient level of contact, a        single control signal instructing locking of the plurality of        locking mechanisms.

According to an aspect of some embodiments of the present inventionthere is provided a surgical system, comprising:

circuitry which analyses images collected by an imager to providemeasurement of movement of joints of a user limb;

a device sized and shaped for insertion into a body, which devicecomprising a first device limb;

at least one controller for moving joints of the device limb based onthe measured movement.

According to some embodiments of the invention, the system comprises adisplay showing images of at least a portion of the device with at leasta portion of a device surroundings. According to some embodiments of theinvention, the system comprises at least one imaging device forcollection of the displayed images. According to some embodiments of theinvention, the at least one imaging device comprises an imaging devicesized and shaped for insertion into a body. According to someembodiments of the invention, the at least one imaging device is coupledto the device.

According to some embodiments of the invention, device comprises asecond device limb. According to some embodiments of the invention, thedevice comprises a third device limb. According to some embodiments ofthe invention, the third limb is larger than the first limb. Accordingto some embodiments of the invention, the third limb includes a camera.According to some embodiments of the invention, the third limb includesfewer portions than the first and the second limb.

According to some embodiments of the invention, the device comprises oneor more tool selected from an access tunnel, a suction element, anirrigation element.

According to an aspect of some embodiments of the present inventionthere is provided a method of jointed mechanism movement, comprising:

measuring user limb movements and a user finger movementssimultaneously;

mapping the measured user limb movements to a device limb and themeasured user finger movements to a device limb tool;

moving the device limb according to the mapped movements;

actuating the device limb tool according to the user finger movements;

wherein the moving and the actuating are simultaneous.

According to an aspect of some embodiments of the present inventionthere is provided a method of control of a surgical system including asurgical device comprising:

measuring movement of at least one user body portion;

detecting, from the measured movement, a system control gesture surgicaldevice control movements;

controlling the surgical device based on detected surgical devicecontrol movements, or changing a state of the surgical system, based ona stored system state transition associated with the detected controlgesture;

wherein the system includes a plurality of states, of measured movementof an input object for control of movement of the surgical.

According to some embodiments of the invention, the plurality of statesuses a different mapping. According to some embodiments of theinvention, plurality of states includes a motion control state wheremovements of an input device are mapped to control movement of thesurgical device. According to some embodiments of the invention, theplurality of states includes a pause state where movements of an inputdevice are not mapped to movement of the surgical device.

According to an aspect of some embodiments of the present inventionthere is provided a method of jointed device movement inside a bodycomprising: measuring movement of at least one user body portion;mapping the measured user body portion movement to a device portionmovement; moving the device portion according to mapped measuredmovements.

According to an aspect of some embodiments of the present inventionthere is provided a method of jointed device movement inside a body,comprising: measuring movement of joints of a first user limb and jointsof a second user limb simultaneously; mapping the measured movements ofthe first user limb joints to joints of a first device limb and themeasured movements of the second user limb joints to joints of a seconddevice limb; moving simultaneously the device limbs according to themapped movements.

According to an aspect of some embodiments of the present inventionthere is provided a surgical system, comprising: a camera formeasurement of movement of joints of a user limb; a device sized andshaped for insertion into a body comprising a first device limb; atleast one controller for moving joints of the device limb based on themeasured movement.

According to an aspect of some embodiments of the present inventionthere is provided a device sized and shaped for insertion into a bodycomprising:

at least one mechanical limb comprising:

a support segment;

a first flexible section extending from the support segment andterminating in a coupling section; and

a second flexible section extending from the coupling section andterminating in a tool or a connector for a tool;

wherein one or more of the flexible sections is bendable by at least120°;

wherein a long axis length of the first flexible section is at leastdouble a maximum extent of the first flexible section perpendicular to aflexible section long axis;

wherein a long axis length of the second flexible section is at leastdouble a maximum extent of the second flexible section perpendicular toa flexible section long axis.

According to an aspect of some embodiments of the present inventionthere is provided a device sized and shaped for insertion into a bodycomprising:

at least one mechanical limb comprising:

a support segment;

a first flexible section extending from the support segment andterminating in a coupling section; and

a second flexible section extending from the coupling section andterminating in a tool or a connector for a tool;

wherein one or more of the flexible sections is in a single bendingplane;

wherein one or more of the flexible sections is bendable by at least120°.

According to some embodiments of the invention, each the flexiblesection has:

a flexible section long axis length; and

a maximum flexible section extent perpendicular to the long axis;

wherein at least one of the flexible sections long axis length is atleast double a maximum flexible section extent perpendicular to the longaxis of the at least one of the flexible sections.

According to an aspect of some embodiments of the present inventionthere is provided a method of treatment comprising:

inserting a mechanical limb into a body, where the limb comprises atleast two flexible portions;

bending the jointed mechanical limb within the body at two or more ofthe flexible sections to contact a target, such that a sum of anglesbetween adjacent effective segment long axes, in at least one threedimensional plane, is at least 120°; and

treating the target with the mechanical limb.

According to an aspect of some embodiments of the present inventionthere is provided a method of treatment comprising:

inserting a mechanical limb into a body through an entrance point in thebody, where the limb comprises at least two flexible portions;

bending the jointed mechanical limb within the body at two or more ofthe flexible sections to contact a target, such that a length of thelimb within the body measured as a sum of long axis lengths of portionsof the limb is at least double a distance between the target and theentrance point;

treating the target with the mechanical limb.

According to an aspect of some embodiments of the present inventionthere is provided a method of hysterectomy comprising:

inserting a device comprising at least one mechanical limb into a bodythrough an incision in a vaginal cavity;

bending the at least one mechanical limb within the body around 30% of alargest dimension of a uterus to access the uterus from outside theuterus;

separating the uterus from surrounding tissue using the mechanical limb;and

removing the uterus through the incision.

According to an aspect of some embodiments of the present inventionthere is provided a device for incision comprising:

a device body sized and shaped to arrange patient tissue with a desiredincision region of the tissue at a cutting edge disposed on the devicebody; and

an outlet disposed on the device body coupled to a suction element forincreasing a pressure between the user anatomy and the device body

According to an aspect of some embodiments of the present inventionthere is provided a uterus manipulator comprising:

a portion sized and shaped for insertion into a uterus;

an elongated device body coupled to the portion for control of a portionposition with respect to the elongated device body;

wherein the elongated device body is adapted to attach to a portion of acervix.

According to an aspect of some embodiments of the present inventionthere is provided a surgical system comprising:

at least one mechanical arm; and

a retractor tool;

wherein the retractor tool is extendable away from the one or moremechanic arm.

According to an aspect of some embodiments of the present inventionthere is provided a device sized and shaped for insertion into a bodycomprising:

at least one mechanical limb comprising:

a support segment;

a first flexible section extending from the support segment andterminating in a coupling section; and

a second flexible section extending from the coupling section andterminating in a tool or a connector for a tool;

wherein a long axis of one or more of the flexible sections is bendablein a single bending plane;

wherein a long axis length of the first flexible section is at leastdouble a maximum extent of the first flexible section perpendicular to aflexible section long axis;

wherein a long axis length of the second flexible section is at leastdouble a maximum extent of the second flexible section perpendicular toa flexible section long axis.

According to an aspect of some embodiments of the present inventionthere is provided a device sized and shaped for insertion into a bodycomprising:

at least one mechanical limb comprising:

a support segment;

a first flexible section extending from the support segment; andterminating in a coupling section;

a second flexible section extending from the coupling section andterminating in a tool or an connector for a tool; and

a control portion comprising at least one flexible torque transferportion and coupled to the second flexible section, rotation of thecontrol portion thereby rotating the second flexible section;

wherein the control portion passes through a hollow portion of the firstflexible section, the flexible torque transfer portion is disposedwithin the first flexible portion, bending of the first flexible portionthereby bending the torque transfer portion.

According to an aspect of some embodiments of the present inventionthere is provided a device sized and shaped for insertion into a bodycomprising:

at least one mechanical limb comprising a portion comprising

a support segment;

a first flexible section extending from the support segment andterminating in a coupling section; and

a second flexible section extending from the coupling section;

wherein the first flexible section comprises bendable torque transfersection;

wherein a long axis of the second flexible section is bendable in asingle bending plane.

According to an aspect of some embodiments of the present inventionthere is provided a grasper comprising:

-   -   at least two opposing portions coupled at a joint;

a torque element coupled to the opposing portions;

wherein application of torque in a first direction to the torque elementscrews the torque element towards the first and second opposingportions, increasing a separation between the portions;

wherein application of torque in a second direction to the torqueelement screws the torque element away from the first and secondopposing portions, decreasing a separation between the portions.

According to an aspect of some embodiments of the present inventionthere is provided a surgical system comprising:

-   -   at least one mechanical limb sized and shaped for insertion into        a body;

one or motor coupled to the limb for moving one or more part of thelimb; and

a processor configured to:

-   -   receive measurement of movement of input object;    -   generate a motor control signal based on the measured input        object    -   movement; and    -   send the motor control signal to the one or more motor thereby    -   controlling movement of the at least one mechanical limb.

Unless otherwise defined, all technical and/or scientific terms usedherein have the same meaning as commonly understood by one of ordinaryskill in the art to which the invention pertains. Although methods andmaterials similar or equivalent to those described herein can be used inthe practice or testing of embodiments of the invention, exemplarymethods and/or materials are described below. In case of conflict, thepatent specification, including definitions, will control. In addition,the materials, methods, and examples are illustrative only and are notintended to be necessarily limiting.

Implementation of the method and/or system of embodiments of theinvention can involve performing or completing selected tasks manually,automatically, or a combination thereof. Moreover, according to actualinstrumentation and equipment of embodiments of the method and/or systemof the invention, several selected tasks could be implemented byhardware, by software or by firmware or by a combination thereof usingan operating system.

For example, hardware for performing selected tasks according toembodiments of the invention could be implemented as a chip or acircuit. As software, selected tasks according to embodiments of theinvention could be implemented as a plurality of software instructionsbeing executed by a computer using any suitable operating system. In anexemplary embodiment of the invention, one or more tasks according toexemplary embodiments of method and/or system as described herein areperformed by a data processor, such as a computing platform forexecuting a plurality of instructions. Optionally, the data processorincludes a volatile memory for storing instructions and/or data and/or anon-volatile storage, for example, a magnetic hard-disk and/or removablemedia, for storing instructions and/or data. Optionally, a networkconnection is provided as well. A display and/or a user input devicesuch as a keyboard or mouse are optionally provided as well.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

Some embodiments of the invention are herein described, by way ofexample only, with reference to the accompanying drawings and images.With specific reference now to the drawings and images in detail, it isstressed that the particulars shown are by way of example and forpurposes of illustrative discussion of embodiments of the invention. Inthis regard, the description taken with the drawings and images makesapparent to those skilled in the art how embodiments of the inventionmay be practiced.

In the drawings:

FIG. 1A is a simplified schematic side view of a surgical deviceincluding a plurality of arms, according to some embodiments of theinvention;

FIG. 1B is a simplified schematic of a device including a plurality ofarms, according to some embodiments of the invention;

FIGS. 1C-1D are simplified schematic side views of mechanical arms,according to some embodiments of the invention;

FIG. 2A is a simplified schematic side view of a mechanical arm,according to some embodiments of the invention;

FIG. 2B is a simplified schematic of two segments connected by a joint,according to some embodiments of the invention;

FIG. 2C shows illustrations of possible limb positions, and/or movementof a device with time, according to some embodiments of the invention;

FIG. 3 is a simplified schematic side view of a hand segment, accordingto some embodiments of the invention;

FIG. 4A is a simplified schematic side view of a device where devicehumanoid proportions are illustrated by comparison to a simplifiedschematic of a human upper body, according to some embodiments of theinvention;

FIG. 4B is a simplified schematic side view of a mechanical arm,according to some embodiments of the invention;

FIG. 5A shows illustrations of possible device positions, and/ormovement of a device with time, according to some embodiments of theinvention;

FIGS. 5B-5D are simplified schematic side views of a mechanical arm,according to some embodiments of the invention;

FIG. 6 is a simplified schematic side view of a device including aplurality of arms, according to some embodiments of the invention;

FIG. 7 is a simplified schematic side view of a device including morethan two arms, according to some embodiments of the invention;

FIG. 8 is a simplified schematic block diagram of a surgical system,according to some embodiments of the invention;

FIG. 9A is a simplified schematic of a device including a plurality ofarms and a camera, according to some embodiments of the invention;

FIG. 9B is a simplified schematic of a device including a plurality ofarms and a camera, according to some embodiments of the invention;

FIG. 9C is a simplified schematic of a device including a plurality ofarms and a camera bent at a device shoulder joint, according to someembodiments of the invention;

FIG. 9D is a simplified schematic of a device including a plurality ofarms and a camera bent at a device shoulder joint, according to someembodiments of the invention;

FIG. 10A is a simplified schematic of a device including a plurality ofarms and a camera, according to some embodiments of the invention;

FIG. 10B is a simplified schematic side view of part of a motor unit foractuation of a device including more than two arms, according to someembodiments of the invention;

FIG. 11A is a simplified schematic view of a system where a device isheld by a support, according to some embodiments of the invention;

FIG. 11B is a simplified schematic view of a system where a device isheld by a support, according to some embodiments of the invention;

FIG. 12 is a simplified schematic side view of a system including adevice with two arms held by a support, and coupled to an operatingsurface, according to some embodiments of the invention;

FIG. 13 is a simplified schematic side view of a system including a portcoupled to an operating surface by a support, according to someembodiments of the invention;

FIG. 14 is a simplified schematic side view of a system including a portsupport and a device support, according to some embodiments of theinvention;

FIG. 15 is a simplified schematic of a device, held by a support,according to some embodiments of the invention;

FIG. 16 is a flowchart of a method of use of a device, according to someembodiments of the invention;

FIG. 17A is a simplified schematic of a single incision in a patient,according to some embodiments of the invention;

FIG. 17B is a simplified schematic of multiple incisions in a patient,according to some embodiments of the invention;

FIG. 17C is a simplified schematic of an incision in a patient,according to some embodiments of the invention;

FIG. 18 is a simplified schematic of a device inserted through a naturalorifice performing surgery, according to some embodiments of theinvention;

FIG. 19 is a simplified schematic of an arm with nested segmentextensions, according to some embodiments of the invention;

FIG. 20 is a simplified schematic of an arm, including a segmentextension 2024E with a bendable torque transfer portion, according tosome embodiments of the invention;

FIG. 21 is a simplified schematic of a torque transfer element accordingto some embodiments of the invention;

FIG. 22 is a torque transfer portion spreading pattern, according tosome embodiments, of the invention;

FIG. 23 is a simplified schematic side view of a straight torquetransfer portion with a first and a second link, according to someembodiments of the invention;

FIG. 24 is a simplified schematic side view of a bent torque transferportion with two links, according to some embodiments of the invention;

FIG. 25 is a simplified schematic side view of a straight torquetransfer portion with plurality links, according to some embodiments ofthe invention;

FIG. 26 is a simplified schematic side view of a bent torque transferportion with a plurality of links, according to some embodiments of theinvention;

FIG. 27 is a simplified schematic of a straight joint including twolinks, according to some embodiments of the invention;

FIG. 28 is a simplified schematic of a joint including two links, wherethe links are rotated about a joint long axis, according to someembodiments of the invention;

FIG. 29 is a side view of a joint including a plurality of links, wherethe links are rotated about a joint long axis, according to someembodiments of the invention;

FIG. 30 is a simplified schematic side view of a joint including aplurality of links, where a plurality of links include guiding rings,according to some embodiments of the invention;

FIG. 31A is a simplified schematic cross sectional view of an arm withnested segment extensions, according to some embodiments of theinvention;

FIG. 31B is a simplified schematic of a side view of a portion of anarm, according to some embodiments of the invention;

FIG. 31C is a simplified schematic cross sectional view of an arm withnested segment extensions, according to some embodiments of theinvention;

FIG. 32 is a simplified schematic cross sectional view of an exemplaryarm with nested segment extensions, according to some embodiments of theinvention;

FIG. 33A is a simplified schematic of a hand tool coupled to a radius,coupled to a radius segment extension, according to some embodiments ofthe invention;

FIG. 33B is a simplified schematic cross sectional view of a portion ofa radius extension, according to some embodiments of the invention;

FIG. 33C is a simplified schematic cross sectional view of a portion ofa radius extension, according to some embodiments of the invention;

FIG. 34A is a simplified schematic side view of a device arm portionincluding a humerus coupled to a humerus extension, according to someembodiments of the invention;

FIG. 34B is a simplified schematic cross sectional view of a humeruscoupled to a humerus extension, according to some embodiments of theinvention;

FIG. 35A is a simplified schematic side view of a shoulder joint coupledto a torso, according to some embodiments of the invention;

FIG. 35B is a simplified schematic cross sectional view of a shoulderjoint coupled to a torso, according to some embodiments of theinvention;

FIG. 36A is a simplified schematic of a closed grasper hand tool,according to some embodiments of the invention;

FIG. 36B is a simplified schematic of an open grasper hand tool,according to some embodiments of the invention;

FIG. 37 is a simplified schematic of a closed grasper hand tool,according to some embodiments of the invention;

FIG. 38 is a simplified schematic of a gripper hand tool, according tosome embodiments of the invention;

FIG. 39 is a simplified schematic side view of an actuation mechanismfor control of a mechanical limb joint, according to some embodiments ofthe invention;

FIG. 40 is a simplified schematic side view of a motor unit foractuation of a device including mechanical arms, according to someembodiments of the invention;

FIG. 41 is a simplified side view of a portion of a motor unit includingelements for electrical supply to an end effecter, according to someembodiments of the invention;

FIG. 42 is a simplified schematic block diagram of a control system,according to some embodiments of the invention;

FIG. 43 is a flow chart of a method of control of a device arm,according to some embodiments of the invention;

FIG. 44A is a photograph of a user controlling a surgical device usingan input device, according to some embodiments of the invention;

FIG. 44B is a photograph of a user controlling a surgical device usingan input device, according to some embodiments of the invention;

FIG. 45 is a simplified schematic illustrating use of a surgical system,according to some embodiments of the invention;

FIG. 46 is a simplified schematic side view of a display includingmotion detection sensors, according to some embodiments of theinvention;

FIG. 47A and FIG. 47B are simplified schematics of a surgical system,according to some embodiments of the invention;

FIG. 48A is a simplified schematic side view of an input device arm,according to some embodiments of the invention;

FIG. 48B is a simplified schematic side view of a surgical device arm,according to some embodiments of the invention;

FIG. 48C is a simplified schematic side view of an input device arm,according to some embodiments of the invention;

FIG. 49A is a simplified schematic side view of an input device,according to some embodiments of the invention;

FIG. 49B is a simplified schematic side view of an input deviceincluding handles according to some embodiments of the invention;

FIG. 50A is a simplified schematic of a controller, according to someembodiments of the invention;

FIG. 50B is a simplified schematic of a controller held by a user,according to embodiments of the invention;

FIG. 51 is a simplified schematic side view of an input device armincluding a handle, according to some embodiments of the invention;

FIG. 52A is a simplified schematic side view of an input device armincluding a handle, according to some embodiments of the invention;

FIG. 52B is a simplified schematic side view of a surgical device arm,according to some embodiments of the invention;

FIG. 53A is a simplified schematic side view of an input device armincluding a handle, according to some embodiments of the invention;

FIG. 53B is a simplified schematic side view of an input device armincluding an extended handle, according to some embodiments of theinvention;

FIGS. 54A-54C are simplified schematic side views of a portion of aninput device arm including a connection between input device segments indifferent configurations, according to some embodiments of theinvention;

FIG. 55A is a simplified schematic side view of an input device armconnecting portion including a locking element in an unlockedconfiguration, according to some embodiments of the invention;

FIG. 55B is a simplified schematic side view of a portion of an inputdevice arm connecting portion including a locking element in a lockedconfiguration, according to some embodiments of the invention;

FIG. 56 is a simplified schematic side view of an input device armconnecting portion including a locking mechanism, according to someembodiments of the invention;

FIG. 57 is a series of photographic illustrations showing movement of auser and of a device arm, according to some embodiments of theinvention;

FIG. 58 illustrates control of a device arm using motion capturetechnology, according to some embodiments of the invention;

FIG. 59A and FIG. 59B are simplified schematic illustrations of bodypoints the position and/or movement of which are measured, according tosome embodiments of the invention;

FIG. 60A is a simplified schematic side view of a surgical device arm ina straight configuration, according to some embodiments of theinvention;

FIG. 60B is a simplified schematic side view of an input device armstraightened by a jig, according to some embodiments of the invention;

FIG. 61 is a flow chart of a method of re-initialization, according tosome embodiments of the invention;

FIG. 62A is a simplified schematic side view of a surgical device arm6204, according to some embodiments of the invention;

FIG. 62B is a simplified schematic side view of an input device arm 6204ip unaligned to the surgical device arm of FIG. 62A, according to someembodiments of the invention;

FIG. 62C is a simplified schematic side view of an input device armrealigned to the surgical device arm of FIG. 62A, according to someembodiments of the invention;

FIG. 63A is a simplified schematic of exemplary system modes, accordingto some embodiments of the invention;

FIG. 63B is a simplified schematic illustration of exemplary states andgestures for transition between states, according to some embodiments ofthe invention;

FIG. 64A is a simplified schematic of an open user hand, according tosome embodiments of the invention;

FIG. 64B is a simplified schematic of a portion of a device armincluding a hand tool where the hand tool is in an open position,according to some embodiments of the invention;

FIG. 64C is a simplified schematic of a closed user hand, according tosome embodiments of the invention;

FIG. 64D is a simplified schematic of a portion of a device armincluding a hand tool where the hand tool is in a closed position,according to some embodiments of the invention; and

FIG. 65 is a series of photographic illustrations showing exemplarycontrol of a device hand using measured user hand position, according tosome embodiments of the invention.

DESCRIPTION OF SPECIFIC EMBODIMENTS OF THE INVENTION

The present invention, in some embodiments thereof, relates to of adevice including mechanical arms, more particularly, but notexclusively, to methods and apparatus for control of a surgical deviceincluding mechanical arms.

Overview

A broad aspect of some embodiments of the invention relates to controlof a surgical device using measured movement of one or more inputobject, where both the surgical device and one or more input objectinclude a sequential structure of connected portions where movement ofone or more portion of the input object controls movement of asequentially corresponding portion of the surgical device.

For example, in some embodiments, input object joints correspond toflexible portions of a surgical device e.g. each input object jointcorresponds to a single flexible portion of a surgical device.

In some embodiments, an input object includes user body portion/s, forexample, where measured movement of a user limb controls movement of asurgical device limb. In some embodiments, an input object includes aninput device which is moved (e.g. manually) by a user. In someembodiments, an input device includes an input device limb wheremovement of the input device limb controls movement of a correspondingsurgical device limb. In some embodiments, a surgical device iscontrolled both by measured movement of a user's body and by movement ofan input device controlled by a user.

A broad aspect of some embodiments of the invention relates to anintuitively controllable surgical system.

In some embodiments, the system includes an input object with astructure similar to that of a surgical device, where movement of theinput object controls movement of the surgical device:

In some embodiments, a ratio between effective segment lengths of aninput device segment pair (e.g. two adjacent input device segments) issubstantially the same as an effective segment length ratio between acorresponding surgical device segment pair.

In some embodiments, each driven portion of the surgical device has acorresponding portion of the input device. In some embodiments, asurgical device arm and an input device arm include segments coupled byconnecting portions. In some embodiments, an input device arm includesat least the number of joints and/or segments as a correspondingarticulated surgical device arm. In some embodiments, the input deviceand the surgical device include the same number of segments and/or thesame number of connecting portions.

In some embodiments, one or more portion of an input device has the samedegrees of freedom as that of a corresponding portion of a surgicaldevice. For example, in some embodiments, input device portion/s arebendable by about the same amount as corresponding surgical deviceportions. For example, surgical device portion/s which are rotatablearound the surgical device portion long axis correspond to input deviceportions which are rotatable around the input device portion long axis.

Potentially, similar structure of the input object and surgical deviceprovides intuitive control of the surgical device.

Overview—Exemplary Input Device Motion Control A broad aspect of someembodiments of the invention relates to an input device for control of asurgical device, where both the input device and the surgical devicehave at least one part (e.g. limb) including a sequential structure ofconnected portions where movement of one or more portion of the inputdevice controls movement of a sequentially corresponding portion of thesurgical device. In some embodiments, a sequential structure of theinput device and/or the surgical device includes segments (e.g. rigidportions) connected by connecting portions (e.g. pivot joints and/orflexible sections).

In some embodiments, sequential coupling of portions the surgical and/orinput device is linear sequential coupling, where for example, centrallongitudinal axes of the portions are collinear where the portions arecoupled.

In some embodiments, an input device limb includes segments sequentiallycoupled by joints. In some embodiments, a surgical device limb includessequentially coupled flexible portions, optionally coupled by surgicaldevice segments. In some embodiments, freedom of movement of inputdevice segments about joints is about the same as freedom of movement ofcorresponding surgical device flexible portions. For example, in someembodiments, a flexible surgical device portion is bendable by the sameangle as an angle between two input device segments coupled by a jointcorresponding to the flexible surgical device portion.

In some embodiments, an angle between long axes of input device segmentscoupled by a joint controls an angle of a corresponding surgical deviceflexible portion. Where, for example, an angle of the surgical deviceflexible portion is defined between long axis tangents of the flexibleportion at the flexible portion ends. Where, for example, an angle ofthe surgical device flexible portion is defined as an angle betweeneffective segment long axis (e.g. where effective segment axes aredescribed herein).

In an exemplary embodiment, an input device includes a more angularshape and/or a shape with a larger relative lateral extent than that ofthe surgical device. For example, in an exemplary embodiment, inputdevice connecting portions are pivot connections between rigid segments,whereas surgical device connecting portions are long bendable sections(e.g. as described in the section of this document entitled “Exemplarylong joints”). In some embodiments, pivot points connecting sections ofthe input device are not disposed at an intersection between effectiveinput device limbs for example, potentially reducing a differencebetween input device and surgical device structures.

In some embodiments, an angle between an input device radius and aninput device humerus controls an angle between a surgical device radiusand a surgical device humerus where a ratio between effective lengths ofthe input device radius and humerus is substantially the same as a ratiobetween effective lengths of the surgical device radius and humerus.

In some embodiments, surgical device movements are scaled user handmovements.

For example, in some embodiments, a user selects scaling of user handmovement to input device (and surgical device) movement by selectingwhere to grasp an input device segment.

For example, in some embodiments, an input device includes a handle(optionally extendable) for scaling user hand movements.

In some embodiments, an input device includes one or more portion whichis scaled up from that of the surgical device (e.g. a portion of theinput device is a scaled up portion of a surgical device) meaning thatlarge user hand movements transfer to small surgical device movements,potentially facilitating fine control of the surgical device with user(e.g. hand) movements.

In some embodiments, corresponding portions of the input device and thesurgical device have differing numbers of segments and/or connectingportions. For example, in some embodiments, an input device segmentcontrols movements of more than one portion of a surgical device (e.g.several segments). For example, in some embodiments, an input deviceincludes two segments (e.g. rigid segments) connected by a connectingportion (e.g. a pivot) which control a portion of the surgical devicewhich includes more than one two portion and/or more than one connectingportion. In some embodiments, an input device includes two segments(e.g. rigid segments) connected by a connecting portion (e.g. a pivot)which controls a portion of the surgical device including an extendedflexible portion (e.g. surgical device includes an endoscope structure).In some embodiments, where a number of input device portions controls adifferent number of surgical device portions, mapping includesidentifying effective segments, for example, where an effective inputdevice segment includes a different number of input device portions thana corresponding surgical device segment.

In some embodiments, a surgical device includes one or more extendingportion (e.g. one or more segment and/or joint which increases in longaxis length). In some embodiments, an input device includes acorresponding extendable portion, the extent of extension of whichcontrols an extent of extension of a corresponding surgical deviceportion.

In some embodiments, a user manually moves portion/s of the input deviceto control movement of the surgical device. In some embodiments, a usercontrols position of more than one part of the device simultaneously,for example, using one hand. In some embodiments, the input deviceincludes two limbs (also herein termed “arms”), and a user controls eachlimb with one hand.

In some embodiments, the input device includes one or more armconstructed from rigid portions interconnected by joints. In someembodiments, the input device has a small number of freely moveablesegments. For example, less than ten or less than 5, or less than 4segments which are concurrently freely movable. Potentially, a smallnumber of freely moveable segments facilitates user control of positionand/or movement of each segment, for example, with a single user handgrasping a segment.

In some embodiments, input device arm/s have a similar structure and/orfreedom of movement as human arms, potentially making manual control ofmovement and/or positioning of segments intuitive for a human user.

In some embodiments, an angle between long axes of two adjacent inputdevice segments controls an angle between long axes of two correspondingadjacent surgical device segments. In some embodiments, a rotation ofone or more input device segment controls rotation of a correspondingsurgical device segment.

An aspect of some embodiments of the invention relates to an inputdevice where joints coupling segments of the device are sufficiently lowfriction that the input device which is easily moveable by a user, whena user is controlling the surgical device by moving the input device. Insome embodiments, the input device is resistive to movement which is notinitiated by a user, the input device, for example including one or morelocking mechanism. For example, potentially preventing accidentalmovement of a surgical device by undesired movement of the input device.In some exemplary embodiments of the invention, the input device has lowresistance joints and includes one or more elements which canselectively lock a joint.

An aspect of some embodiments of the invention relates to an inputdevice including one or more locking mechanism where the lockingmechanism, when in a locked configuration, prevents movement of segmentsat a joint. In some embodiments, when the input device is not in use,the device is locked in position (e.g. automatically), for example,preventing movement of the surgical device.

In some embodiments, an input device locking mechanism includes one ormore element (e.g. a toothed element) which interlocks with gear/scoupled to the joint to portion/s (e.g. at an input device joint) of theinput device in position. In some embodiments, an input device lockingmechanism includes an element which frictionally holds portion/s of theinput device in position.

In this document, where the term “device” is used without a qualifier,the term refers to a surgical device including one or more articulatedlimb.

In some embodiments, one or more portion of a device is controlled bymeasured movement of an object (e.g. an avatar, also herein termed“input device”) moved by a user. In some embodiments, an avatarmanipulated by a user is a representation, optionally miniaturized, ofat least a portion of a device (e.g. device arm). For example, one ormore device portion (e.g. joint) is controlled by position and/ormovement of a corresponding avatar portion (e.g. joint).

In some embodiments, movement of the avatar is measured using motioncapture technology. In some embodiments, movement of the avatar ismeasured using one or more sensor e.g. mounted on and/or in the avatar.

In some embodiments, a user positions the device avatar with respect toa model of one or more portion of user anatomy, for example, a usermoves an avatar to perform a treatment on an anatomic model and thedevice performs the treatment on the corresponding anatomy of a patient.

Overview—Exemplary Surgical Device Tool Control

A broad aspect of some embodiments of the invention relates to controlof surgical device tools (e.g. end effecter/s coupled to distal end/s ofsurgical device limb/s). For example, control of opening and/or closingof a surgical device tool including two or more opposing sections (e.g.a gripper).

In some embodiments, an input device includes one or more userinterface, for example, for controlling a surgical device end effecter.In some embodiments, surgical device end effecter/s are controlled bybutton/s located on the input device. In some embodiments, the inputdevice includes representation/s of the surgical device end effecter/s,for example, so that a user can view a configuration of the surgical endeffecter/s by looking at the input device.

In some embodiments, control of one or more device hand tool by mappedmovement of a user hand and/or wrist movement and/or movement of a toolheld by a user. In some embodiments, a device arm includes one or morehand tool coupled to the radius segment at a wrist joint. In anexemplary embodiment, each device arm includes a hand tool.

In some embodiments, a device hand tool includes more than one part andhas an open and a closed configuration, where separating distal ends ofthe parts opens the tool and bringing distal ends of the parts togethercloses the tool (e.g. scissors, grasper with two or more opposingportions). In some embodiments, opening and closing of a device tool,“tool actuation”, is controlled by opening and closing of a user hand,“user tool actuation”.

In some embodiments, a device tool is controlled by measured movement ofan object representing the tool, a “tool avatar” which held and/or movedby a user. For example, in some embodiments, a device including ascissors tool is controlled by a user holding a pair of scissors e.g.opening and closing of the device scissors (tool actuation) iscontrolled by opening and closing of the avatar scissors “avataractuation”. In some embodiments, a tool avatar is unattached tosupporting element/s. In some embodiments, a tool avatar is coupled toan input device. In some embodiments, rotation of a tool avatar controlsautomatic (e.g. robotically controlled) movement of a mechanical arm.

In some embodiments, rotation of a device hand and/or hand tool iscontrolled by measuring user finger position (e.g. using motion capturetechnology and/or a one or more sensor mounted on a user hand). In someembodiments, rotation of the hand is controlled by measuring orientationof a tool avatar (e.g. using motion capture technology and/or using oneor more sensor optionally mounted on the avatar).

In some embodiments, device arm movement and device tool actuation aresynchronized (e.g. occur at the same time), according to synchronizeduser arm movement and user tool actuation and/or avatar tool actuation,optionally, for more than one arm and/or more than one device hand tool.In some embodiments, simultaneous measurement of user movements controldevice arm movement and tool actuation (e.g. opening and closing of thedevice).

Overview—Exemplary User Body Motion Control

A broad aspect of some embodiments of the invention relates to controlof a jointed mechanical device where movement of one or more deviceportion is controlled by measured mapped movement of a correspondinguser body portion (e.g. movement of a device elbow joint is controlledby measured mapped movement of a user elbow joint). In some embodiments,each device joint is controlled by measured movement of a correspondinguser arm joint.

In some embodiments, one or more device arm portion is controlled bymeasured movement of a corresponding user arm portion and/or measuredmovement of a corresponding input device and remaining device portionsare controlled using robotics, e.g. inverse kinematics. For example, insome embodiments, device arms are outstretched, and (e.g. to provide theuser with a comfortable working arm position) user humerus segments areheld downwards, at the user sides. User hand, radius and wrist positioncontrol movement of the device hand, radius and wrist position and elbowand shoulder position and movement are controlled by inverse kinematics.

In some embodiments, position and/or movement of one or more user bodyportion (e.g. segment joint and/or segment) is measured in 3D space e.g.with motion capture technology. For example, relative positions and/ormovement of user segment (e.g. arm) joints are extracted from capturedimages (e.g. video images). Alternatively or additionally, measurementsare collected by one or more motion sensor attached to the user. In someembodiments, a motion sensor is attached to each user segment and/orjoint to be measured.

In some embodiments, one or more changing angle between two user armsegments is calculated from measured user joint movement. In someembodiments, corresponding device arm segment/s are moved according tothe measured changing angle/s. In some embodiments, a user skeleton(e.g. including joint position and segment position) is modeled frommeasurements. In some embodiments, the modeled skeleton is used tocontrol the surgical device limbs.

In some embodiments, control is relative for one or more portion of thedevice, the device changing an angle between two segments according tothe corresponding user change in angle, for example if device and userstarting angles are not the same, if the device has different anatomy(e.g. different segment ratios) than the user arm. In some embodiments,the device angle is changed by approximately the same number of degrees.In some embodiments, the device angle is changed by a scaled number ofdegrees.

Potentially, device control using measured user movement provides one ormore of; user movements which are physically comfortable, and/or usercontrol movements are intuitive and/or easily learnt, for example,resulting in a low amount of error movements.

In some embodiments, a user controls one or more device segment usinguser leg motion.

Overview—Exemplary System Modes

An aspect of some embodiments of the invention relates to transfer ofthe system between modes. In some embodiments, transfer is by detectionof user gestures. For example, in some embodiments, a user transfers thesystem from a mode where measured user movement is mimicked by thesurgical device to a pause mode, where mimicking ceases, by the userperforming a gesture (e.g. lifting a user leg).

In some embodiments, the device is operated in more than one mode (e.g.during a single treatment). In some embodiments, a device is moved intoposition using a mode where each device portion is controlled bymovement of a corresponding user body portion and then, for example,once the device hands are in position to e.g. operate on tissue, theuser changes the control mode, e.g. to fewer device portions beingcontrolled by user movement (e.g. as described above), e.g. to scaleddown movements for fine work.

In some embodiments, some user body movements and/or gestures are usedto control movement of a surgical device and other user body movementsand/or gestures are used to change a mode of the system.

Overview—General

In some embodiments, one or more surgical device-user arm pair, orsurgical device-input device arm pair is initialized (e.g. beforetreatment with the device) where surgical device arm position (e.g.angles between segments) is aligned with and user and/or input armposition (e.g. device arm and/or user arm are moved duringinitialization).

In some embodiments, movement of one or more portion of the surgicaldevice (e.g. surgical device arm) is substantially at the same time asmovement one or more portion of user and/or input device arms.Alternatively, in some embodiments, movement of the device (e.g. devicearm) is delayed, for example, a user makes a movement (e.g. with theuser's body and/or with an input device), then optionally authorizes themovement for control movement of the device. In some embodiments, one ormore portion of the device moves at the same speed as the usercontrolled (e.g. movement of the user's body and/or user movement of aninput device) movement. Alternatively, in some embodiments, the devicemoves at a different, optionally user defined, speed (e.g. slower). Insome embodiments, a user selects one or more timing option. For example,during fine work, a user selects a mode where user movements are slowedand/or delayed to control device movements.

In some embodiments, the surgical device includes two or more arms. Insome embodiments, movement of two surgical device arms is controlled bymapping movement of two user arms and/or of two input device arms. Insome embodiments, movement of two surgical device arms is synchronizedaccording to synchronized movement of two user arms and/or of two inputdevice arms. A potential advantage of synchronized control of devicearms being the ability of two or more device arms to work together, forexample, to hold and/or stretch tissue and to cut the tissueconcurrently, to grasp a portion of tissue together (e.g. to pass anobject from one hand tool to another).

In some embodiments, a user selects a device limb to be controlled bymapped movement (e.g. control as described above using user movementand/or input device movement) of an input object limb. In someembodiments, the user selects a surgical device limb and selects a userand/or input device limb, and the selected surgical device limb iscontrolled by mapped movement of the selected user and/or input devicelimb. In some embodiments, a device includes more than two arms and auser selects two device arms, where a first device arm is controlled bymapped movement of a first user arm and/or first input device arm and asecond device arm is controlled by mapped measured movement of a seconduser arm and/or a second input device arm. In some embodiments,non-selected arm/s remain stationary and/or are moved with a differentmethod of control (e.g. using user leg motion, controlled by a seconduser, controlled automatically, e.g. by robotics).

In some embodiments, both input device movement and user body movementis used to control the surgical device, for example a first surgicaldevice arm being controlled by user movement of an input device arm anda second surgical device arm being controlled by measured movement ofportion/s of the user's body.

Optionally, the system (for example, as described herein) automaticallyassigns a user arm-surgical device arm pairs (and/or inputdevice-surgical device arm pairs) for control of the surgical devicewhere assignment is based on, for example, position of the surgicaldevice arms (e.g. in some embodiments, the user does not specify whichuser and/or input arm is to control which surgical device arm).

In some embodiments, a user changes selected surgical arms by pausingcontrol (e.g. control of movement of surgical device arm/s by mappedinput object movement) of one or more selected surgical device arm andre-selecting one or more surgical device arm (selecting as describedherein). In some embodiments, the user pauses and re-selects arms toswitch control of a first device arm by a left user arm and control of asecond device arm to control of the second device arm with the userright arm and control of the second device arm by a user left arm.

In some embodiments, a user pauses an initial surgical device arm in adesired position (e.g. to hold user anatomy in position) and selectsanother surgical device arm (e.g. a third arm) for continued two-armmovement.

In some embodiments, user control is assisted by visual feedbackdisplayed to the user (e.g. on a screen), for example, data describing aconfiguration of at least part of the surgical device (e.g. images) isdisplayed, optionally in relation to real time imaged and/or previouslyimaged patient anatomy. In some embodiments, surgical device and/oranatomy images are video images and/or real-time ultrasound imagesand/or CT images and/or MRI images.

An aspect of some embodiments of the invention is related to a surgicalsystem for key-hole surgery including a mechanical device with at leastone limb for insertion into a body where a controller controls themovement of one or more portion of the limb according to measuredmovement of corresponding portion/s of a user limb (measured by ameasurement device, e.g. a camera). In some embodiments, the deviceincludes one or more imaging device for insertion into the body with themechanical arm/s. Optionally, the system includes one or more externalimaging device (e.g. MRI, CT, ultrasound). Optionally collected imagesfrom one or more device are displayed to a user on a display. Optionallyadditional data and/or processed collected data (e.g. from one or moresystem and/or device sensor, from a database) is displayed to the useron the display.

Optionally, in some embodiments, more than one user controls a surgicaldevice, for example, at the same time. In some embodiments, differentusers control different portions of the surgical device, optionallyusing different types of control. For example, in some embodiments, afirst user controls portion/s of a surgical device using an input deviceand a second user controls portion/s of the surgical device withmeasured user body movement. In some embodiments, multi-user control issequential, where, for example, a first user's control movements arecarried out by the surgical device and then a second user's movement.Alternatively, or additionally in some embodiments, multi-user controlmovements are carried out simultaneously by the surgical device

In some embodiments, mapping between input object portions and surgicaldevice portions uses segment lengths. In some embodiments, mapping useseffective lengths, e.g. as defined using method/s (e.g. as described inthis document) for surgical device effective segments and/or effectivesegment lengths. In some embodiments, effective lengths change fordifferent configurations (e.g. angles of bending) of the input objectsIn some embodiments, effective input device segments are defined usingone technique and these effective input device segments and/orrelationships between these effective input device segments (e.g.angle/s between effective segments) are mapped to control correspondingsurgical device segment/s and/or effective segment/s where surgicaldevice effective segment/s are defined using the same or a differenttechnique.

Before explaining at least one embodiment of the invention in detail, itis to be understood that the invention is not necessarily limited in itsapplication to the details of construction and the arrangement of thecomponents and/or methods set forth in the following description and/orillustrated in the drawings and/or the Examples. The invention iscapable of other embodiments or of being practiced or carried out invarious ways.

In some embodiments, an angle between two effective input devicesegments (effective segments e.g. defined as described regarding FIGS.5A-5D) is used to control bending of corresponding effective surgicaldevice segments. For example, in some embodiments, a measured anglebetween two adjacent input device segments, also termed an angle of ajoint connecting the segments is used to generate a control signal foractuation of a flexible portion corresponding to the input devicesegment e.g. bending and/or rotation (about a flexible portion longaxis) of the flexible portion. In some embodiments, an input deviceportion corresponds to a surgical device portion where the surgicaldevice portion is actuated based on measured position and/or relative(e.g. with respect to other input device portion/s) position of theinput device portion.

In some embodiments, control techniques and/or apparatuses for controlas described in this document are performed by devices and/or systemsand/or methods, for example as shown in and/or described regarding FIGS.1A-41 and/or are used in treatments as described herein.

Other devices and/or systems and/or devices (e.g. surgical devices ofthe art) may be controlled using control techniques and/or apparatusesfor control as described herein.

Overview—Exemplary Devices

A broad aspect of some embodiments of the invention relates to anintuitively controllable and flexible mechanical device (e.g. surgicaldevice) for insertion into a patient, including one or more limbs, whereintuitive control is related to the device including at least one limbwith humanoid characteristics:

In some embodiments, a mechanical limb includes at least two coupledflexible portions, and, in some embodiments, movement (e.g. bendingand/or rotation) of a first flexible portion and a second flexibleportion is independently controllable. In some embodiments, one or moreof the flexible portions is independently rotatable about acorresponding flexible portion long axis. In some embodiments, one ofmore the flexible portions is independently flexible and extendable(bendable). In some embodiments, flexion/extension and rotation about aflexible portion long axis of one or more flexible portion arecontrollable concurrently.

In some embodiments, one or more of the flexible portions isunidirectionally flexible and extendable (bendable). For example, insome embodiments, the flexible portion is bendable in one plane (herein“bending plane”) e.g. where a central long axis of the portion bends inone plane. For example, in some embodiments, the flexible portion bendsin one rotational direction around one or more bending plane. Forexample, in some embodiments, in some embodiments, the flexible portionis bendable in one rotational direction around a single bending plane.The term “unidirectionally bendable” herein refers to a portion beingbendable in one rotational direction and/or bendable around a singlebending plane.

In some embodiments, freedom of movement of the flexible sectionsrelates to that of joints of a human arm, for example, the firstflexible portion corresponding to a shoulder joint and the secondflexible portion corresponding to an elbow joint.

In some embodiments, the flexible portions are coupled by a firstsegment (e.g. comprising a coupling section), which, in someembodiments, is rigid, the first segment, for example, corresponding toa humerus. In some embodiments, the first flexible portion is coupled(e.g. at a proximal end of the first flexible portion) to a supportsegment (e.g. corresponding to a torso).

In some embodiments, a limb support segment is long, for example, withrespect to segments of a device limb, for example, 2 times, or 3 times,or 4 times, or 5 times or 10 times or 20 times a length of one or moresegment.

In some embodiments, the first flexible section is multi-directionallybendable, for example, bendable in more than one bending plane (e.g.corresponding to human shoulder joint freedom of movement).

In some embodiments, flexion and rotation of flexible portions (e.g.corresponding, in some embodiments, to flexion and rotation of segmentsat joints) is sufficient such that the range of possible positions offlexible portions and/or segments is at least that of a human arm.

For example, in some embodiments, possible positions of joints includepossible positions of corresponding human arm joints. For example, insome embodiments, a range of possible angles between device limbsegments corresponds with a range of possible angles betweencorresponding human arm segments.

In some embodiments, each device arm segment is flexible and extendablearound a joint. In some embodiments, each segment is rotatable around asegment long axis, which rotation rotates a portion of the arm distal tothe rotating segment about the segment's long axis. In some embodiments,joint flexion/extension and segment rotation are adjustableconcurrently.

In some embodiments, freedom of movement of a device mechanical arm isrestricted, for example, to match an aspect of freedom of movement of ahuman arm. For example, in some embodiments, one or more flexibleportion (e.g. each flexible portion) is uni-directionally bendable.

In embodiments where a mechanical arm includes rigid segments connectedby flexible portions, analogy may be made between rigid segments andhuman arm segments (e.g. humerus and radius) and between flexibleportions and human arm joints (e.g. shoulder, elbow, wrist). In someembodiments, a ratio of lengths (e.g. central long axis lengths) ofsegments is about a normal human ratio, for example, in someembodiments, a ratio between two segment long axis lengths is about anormal human ratio for the corresponding segments. For example, in someembodiments, a mechanical arm humerus length is about 5-40% or 10-30% orabout 20% longer than the radius length, or lower or higher orintermediate ranges or percentages longer.

In some embodiments, an effective lengths and/or ratios betweeneffective lengths of device limb segments corresponds to that of humanlimb segments (e.g. a ratio of humerus to radius length).

In some embodiments, device joint/s are long, such a portions of adevice arm corresponding to a human body segment (e.g. humerus, radius)include portions of device joint/s. In some embodiments, ratio/s ofhuman segment lengths correspond to ratio/s of effective surgical devicesegment lengths, where different definitions for effective segmentlengths are described below.

In some embodiments, one or more ratio between dimensions of differentportions of a mechanical limb is about a normal human ratio for thecorresponding dimensions. For example, in some embodiments, a ratiobetween a length of a portion of the device acting as a humerus(effective humerus length) and a length of a portion of the deviceacting as a radius (effective radius length) is 1:1 to 2:1, or 1.1:1 to1.5:1 or about 1.2:1, or lower or higher or intermediate ratios.

In some embodiments, a ratio of a length of a portion of the deviceacting as a humerus and a length of a portion of the device acting as ahumerus remains fixed as the mechanical arm is moved. In someembodiments, a ratio of a length of a portion of the device acting as ahumerus and a length of a portion of the device acting as a humeruschanges fixed as the mechanical arm is moved.

In some embodiments, a ratio between effective segment lengths is aboutthat of a normal human ratio for the corresponding segments.

In some embodiments, a ratio of effective segment lengths is maintainedwithin a normal human ratio (and/or within a range around a normal humanration) when the mechanical arm is in different configurations (e.g. oneor more flexible portion is bent).

In some embodiments, a mechanical arm lacks one or more of human armsegments (and/or includes one or more segment than the number ofsegments in a human arm) coupling flexible portions. For example, insome embodiments, a mechanical arm lacks a wrist joint. For example, inan exemplary embodiment, a first flexible portion and a second flexibleportion are directly coupled (e.g. a distal end of the first flexibleportion is directly coupled to a proximal end of the second flexibleportion).

An aspect of some embodiments of the invention relates to a mechanicalarm including humanoid structural characteristics where flexibleportions of the mechanical arm are long and are associated with humanarm joints as well as portion/s of rigid (e.g. bone) human arm segments(e.g. humerus, e.g. radius).

In some embodiments, one or more device arm includes a radius segmentand a humerus segment sized, and an elbow joint and shoulder joint withflexion such that a hand and/or distal end of a device radius is movableto near to and/or axially past and/or into contact with the shoulderjoint and/or the arm torso. A potential benefit being the ability toaccess a target (e.g. with hand tools) close to the torso.

An aspect of some embodiments of the invention relates to a flexibledevice where bending portions of the device are rounded for example,with a minimum a radius of curvature of one or more bending portionbeing at most 15 mm, or at most 10 mm, or at most 8 mm, or at most 5 mm.In some embodiments, an inner skeleton (e.g. including mechanical limbsas described herein) includes rounded bending portions. In someembodiments, a cover or sheath covering a mechanical limb includesrounded bending portions. In some embodiments, rounded bending portionsof device mechanical arms are due to an inner structure, and are notonly due to rounded bending portions of a cover or sheath (e.g. aprotective cover). In some embodiments, a mechanical arm has minimallateral extension associated with bending at device flexible portions.

An aspect of some embodiments of the invention relates to a deviceincluding one or more articulated mechanical limb, where one or morejoint (flexible portion) is long. For example, in some embodiments,bending of one or more long joint is distributed along the joint in adirection of a joint long axis.

In some embodiments, a long axis length of a joint is long, e.g. withrespect to a maximum extent of the joint perpendicular to the joint longaxis. In some embodiments, one or more joint is long with respect to oneor more segment length long axis length and/or is long in comparisonwith human joint to segment length ratios and/or is long with respect torigid segment/s of a mechanical arm.

In some embodiments, a long flexible portion includes a central longaxis length of the portion being at least double or 1.5-5 times, or 2-4times, or at least four times, a maximum extent of the flexible sectionperpendicular to the section long axis.

An aspect of some embodiments, of the invention relates to a jointcomprising a chain of coupled elements where bending of the joint is bypivoting of individual elements. In some embodiments, each elementpivots about an element bending plane. In some embodiments, a bendingaxis of one or more of the elements (e.g. all of the elements) iscoplanar. In some embodiments, elements pivot in one direction aroundthe bending axis.

A broad aspect of some embodiments of the invention relates to rotationof a portion of a mechanical arm about a portion long axis, whererotation is rotation of component/s coupled to the portion and extendingaway from the portion.

In some embodiments, an elongate portion (e.g. segment, flexibleportion) of the arm has a main central axis (where the main axis is acentral (e.g. symmetrical) axis of the device with the largest extent),where the main axis is herein termed “long axis” or “central long axis”or “longitudinal axis” or “central longitudinal axis”.

An aspect of some embodiments of the invention relates to actuation ofthin mechanical limbs. In some embodiments, one or more portion of amechanical limb is rotated by rotating a portion coupled to the limb andextending away from the limb. For example, in some embodiments,portion/s of a mechanical limb inserted into a patient are rotated byrotation of a portion extending outside of a patient (e.g. using motor/soutside the patient). In some embodiments, sequentially connectedportions are rotated by portions which extend through hollows withinother portions. In some embodiments, lack of motors located within amechanical limb facilitate thin mechanical limbs.

In some embodiments, a surgical device system includes a motor unitincluding a plurality of motors for driving multiple parts of a surgicaldevice including at least one mechanical limb (e.g. more than one motoris used to drive different portions of a mechanical limb). In someembodiments, the mechanical limb is inserted into a patient body whilethe motor unit remains outside the patient body.

In some embodiments, each segment of a mechanical arm is rotated arounda segment long axis by component/s located externally to the segment.

In some embodiments, one or more portion of a mechanical arm is rotatedby rotation of an extension (also herein termed “control portion”)coupled to the portion, where the extension extends outside the portionand/or arm.

In some embodiments, an extension includes one or more flexible torquetransfer portion able to transfer torque along a torque transfer portionlong axis while the portion is bent, a potential benefit being theability to rotate a portion remotely (e.g. from outside the arm) whenone or more arm joint is flexed and/or extended.

In some embodiments, one or more extension is nested, where theextension passes through (e.g. through a hollow portion of) one or morearm element, for example, through one or more other extension and/or oneor more segment and/or one or more connecting portion. A potentialbenefit of nested extensions is compactness of the mechanical arm and/orsegments forming the external shape of the arm.

In some embodiments, a flexible torque transfer section of an extension(control portion) passes through a hollow portion of, and is alignedwith a flexible portion of the device. In some embodiments, the flexibleportion is unidirectionally bendable. In some embodiments, bending ofthe outer flexible portion causes the torque transfer portion to bend.In some embodiments, a long axis of the torque transfer portionunrestrained in possible planes of bending.

An aspect of some embodiments of the invention relates to control offlexion/extension of a portion of a mechanical limb by varying tensionon elongated element/s coupled to the portion where in some embodiments,one or more elongated element is coupled to an external surface of thedevice limb. In some embodiments, elongated element/s extend outside thedevice (e.g. extend outside a patient body when the device is within apatient body e.g. extend to where they are actuated by a motor unitoutside the patient). In some embodiments, elongated element/s arecoupled to an inside surface of one or more hollow device portion.

An aspect of some embodiments of the invention relates to a bendabletorque transfer portion including a first end and a second end, wherethe portion transfers torque applied to the first end to the second endwhen the portion is bent.

In some embodiments, a torque transfer portion includes a plurality ofelements interconnected by a plurality of connectors. In someembodiments, the connectors are sufficiently strong to transfer torquebetween the elements.

In some embodiments, one or more element (or, in an exemplaryembodiment, each element) includes two or more portions, where theportions are independently elastically compressible and expandable in adirection parallel to a torque transfer portion long axis.

An aspect of some embodiments of the invention is related to a surgicalsystem for key-hole surgery including a mechanical device with at leastone limb for insertion into a body where the device includes humanoidstructural characteristics (e.g. as described herein). In someembodiments, the device is actuated by a motor unit which is notinserted into the body. In some embodiments, the device includes one ormore imaging device for insertion into the body with the mechanicallimb/s. Optionally, the system includes one or more external imagingdevice (e.g. MRI, CT, ultrasound). Optionally collected images from oneor more device are displayed to a user on a display. Optionallyadditional data and/or processed collected data (e.g. from one or moresystem and/or device sensor, from a database) is displayed to the useron the display.

In some embodiments, data displayed to a user includes image and/ormeasurements, optionally processed before display, for example, internaldevice measurements (e.g. from one or more device sensor, for exampleinserted with the device and/or mounted on a device arm).

In some embodiments, optionally displayed images (e.g. video images) arecollected by a camera mounted on the device or inserted with the device,optionally at a position with relation to the arms which mimics humaneye to arm positioning. Optionally, a position of the camera is changedduring use of the device, for example, movement of the camera close todevice hands to provide a close-up view, (e.g. of surgery).

In some embodiments, images are re-orientated before display to a user,for example, images are orientated to an intuitive direction for theuser. For example, in some embodiments, images collected from a firstpoint of view (e.g. by an internal camera) are orientated to a userpoint of view above the body. For example, in some embodiments, two ormore sets of images are orientated to be in the same orientation (e.g.images are overlaid) for example, previously collected images (e.g. CT,MRI) and real time images, for example from internal camera/s and/orinternal and/or external ultrasound.

An aspect of some embodiments of the invention relates to actuation of amechanical device limb. In some embodiments, two gears are driven at thesame speed and direction to provide rotation without bending of a devicelimb flexible portion. In some embodiments, two gears are driven atdifferent speeds and/or direction to provide bending of a device limbflexible portion.

For example, in some embodiments, a first gear and a screw mechanism arecoupled to a central shaft. One or more elongated element is coupledbetween the flexible portion and the screw mechanism, such rotation ofscrew mechanism without rotation of the elongated element/s causes theelongated elements to move laterally along a long axis of the shaft,generating flexion or extension of the flexible portion. In someembodiments, elongated elements are coupled to a second gear. In someembodiments, when both the first and second gears are rotated in thesame direction and speed, the flexible portion rotates and the flexibleportion does not change flexion/extension. In some embodiments, rotationof the second gear while the first gear remains stationary generatesflexion/extension but not rotation of the flexible portion. In someembodiments, when first and second gears are differentially rotated(e.g. in different directions and/or in the same direction at differentspeeds and/or the first gear is rotated while the second gear remainsstationary) the flexible portion both rotates and bends(flexion/extension). In some embodiments, each gear is driven by amotor. In some embodiments, each flexible portion is driven by the abovedescribed mechanism including two gears.

In an exemplary embodiment, the device is inserted into a body through asingle incision. In some embodiments, the device is inserted into anatural orifice (e.g. vagina, rectum, mouth and/or nostril). Optionally,the device is inserted through one or more incision in a naturalorifice.

In some embodiments, the mechanical arms have a small transversedimension, such that, in some embodiments, one or more arm is insertedinto a body through a small incision and/or is inserted into a narrownatural orifice (e.g. vagina) and/or is inserted into a narrow channel(e.g. channel inside natural orifice, e.g. esophagus).

Optionally, in some embodiments, one or more part of a device includesan electrosurgery tip e.g. monopolar electrosurgery tip, bipolarelectrosurgery tip.

In some embodiments, one or more additional component or tool (e.g.service tunnel, suction tool, irrigation tool, inflation tool) areinserted, optionally through a single incision, with the mechanicalarm/s.

An aspect of some embodiments of the invention relates to a mechanicallimb including more than one bendable portion, where bending of at leastone portion is controlled by changing tension of an elongated elementcoupled to the portion and where bending of at least one other portionis controlled by applying torque to (e.g. screw mechanism) an elongatedelement coupled to the portion.

An aspect of some embodiments of the invention is related to a grasperwhere movement of an element (e.g. by a motor) to control actuation ofthe grasper is separated from the grasper by at least a segment (e.g.control of grasper at least at the radius). In some embodiments, grasperactuation is by rotation of a grasper extension coupled to the grasper.

In an exemplary embodiment, grasper actuation is controlled outside thearm, e.g. in the torso of the mechanical arm to which the grasper iscoupled, e.g. outside the device.

In some embodiments, the grasper extension includes one or more graspertorque transfer portion (e.g. as described elsewhere in this document).

In some embodiments, the grasper extension extends away from the grasperthrough one or more hollow portion in one or more segment and/orconnecting section and/or torque transfer portion.

In some embodiments, actuation of the grasper is by a screw mechanismwhere grasper actuation is by turning a grasper extension (e.g. anelongated element) coupled to the grasper and extending away from thegrasper. In some embodiments, continuous rotating of the elongatedelement cyclically opens and closes the grasper. In some embodiments,rotating the elongated element in a first direction (e.g. clockwise)closes the grasper and rotating the elongated element in a seconddirection (e.g. anticlockwise) opens the grasper. A potential benefit ofgrasper actuation by a screw mechanism is, in comparison to grasperactuation being controlled by pulling/releasing an elongated elementwhich extends through at least one segment is that grasper hold on anobject between grasper opposing portions is unaffected by bending and/ormovement of the device arm through which the elongated element travels.

In some embodiments, one or more mechanical limb flexible portion isbendable and/or segment is sized such that a distal end of the limb(optionally including a length of an end effecter) is positionable at alimb support segment. In some embodiments, the support segment istubular.

In some embodiments, a mechanical limb is bendable such that the limb isbendable by 180° or more with respect to a limb support segment.

In some embodiments, a flexible portion includes a plurality of elements(e.g. links, e.g. as described herein). In some embodiments, the termflexible portion refers to a portion which is bent using a singlecontrol and/or as a single unit.

Overview—Exemplary Treatments

A broad aspect of some embodiments of the invention relates to asurgical device for insertion into a body including at least onemechanical limb where the limb is sufficiently flexible such that thedevice is able to bend to access a target from a different direction toa direction of insertion of the mechanical limb.

In some embodiments, a surgical device limb includes at least twoflexible portions where, in some embodiments, at least one of theportions is bendable (flexion/extension) by at least 120°, or by atleast 90, or by at least 100°, or by at least 140°, or by at least 160°,or by at least 180°, or by at least 190°, or by at least 200°, or by atleast 210° or lower or higher or intermediate angles. In someembodiments, bending of two flexible limb sections is of a combinedangle of at least 180°. In some embodiments, one or more flexibleportion is maximally bendable by 400°, 350°, 300°, or 270°. In someembodiments, a limb is maximally bendable by 400°, 350°, 300°, or 270°.

In some embodiments, device limb flexible portion/s are long where, along axis length of at least one flexible section is at least double, orat least 1.5 times, or at least 3 times, or at least 4 times, or atleast 5 times, or at least 8 times or at least 10 times, a maximumextent of the flexible section perpendicular to the flexible sectionlong axis.

An aspect of some embodiments of the invention relates to a surgicaldevice including at least one limb for insertion into a body, where thelimb includes flexible portions which are unidrectionally bendable andis highly bendable (e.g. large possible angle of flexion and/orextension).

In some embodiments, a surgical device limb includes at least twoindependently unidirectionally bendable flexible portions where, in someembodiments, at least one of the portions is bendable(flexion/extension) by at least 120°, or by at least 90-180°, or by atleast 100-120°, or lower or higher or intermediate angles. In someembodiments, bending of two flexible limb sections is of a combinedangle of at least 180°. Where, for example, a sum of a first anglebetween long axis tangents at ends of a first flexible section and asecond angle between long axis tangents at ends of a first flexiblesection are at least 180°. Where, for example, a sum of a first anglebetween long axes of an adjacent segment pair and a second angle betweenlong axes of a different segment pair is at least 180°. Where adjacentsegment pairs are defined as segments directly coupled by a flexiblesection.

In some embodiments, each flexible portion is independently rotatableabout a flexible portion long axis.

A broad aspect of some embodiments of the invention relates to a methodof treatment (e.g. endoscopic surgery), where a device including atleast one jointed mechanical limb is inserted into a body (e.g. apatient), optionally through an incision, where the limb bends withinthe body to access and treat a target (e.g. a body organ). In someembodiments, the ability of the limb to bend within the body is used tocompensate for insertion direction sub-optimality.

In some embodiments, bending of the flexible limb portions, is such thata direction in which the device contacts and/or accesses the target isdifferent (e.g. at least 90° larger or smaller than, in at least one 3Dplane) from a direction of device entry into the body.

In some embodiments, bending of the flexible limb portions, is when atleast two joint angles are each larger than 0°, where joint angles aremeasured as the angle between coupled device segment (and/or effectivesegment) long axes. In some embodiments, bending of the limb is suchthat a sum of all limb joint angles is more than 0°, 10° or more, 45° ormore, or 90° or more, or 180° or more or 360° or more.

In some embodiments, bending of the limb is such that a direction ofdevice entry into the body is different (e.g. at least 10° larger orsmaller, at least 45° larger or smaller, at least 90° larger or smaller)from a direction of a straight line connecting the target to theincision.

In some embodiments, a device including one or more limb accesses atarget by bending around an obstacle. For example, one or more limbbends in a path which curves away from a straight line between theinsertion point and the target (e.g. the path not passing through thetarget, e.g. where the obstacle is between a point of insertion of thedevice and the target). In some embodiments, a device includes more thanone limb. In some embodiments, device limbs approach a target from thesame direction, in some embodiments, device limbs approach a target fromdifferent directions, e.g. with an access direction difference of up to20°, 20° or more, or 45° or more, or 90° or more, or 180° or more or270° or more.

In some embodiments, the target is a portion of an organ and theobstacle is a different portion of the organ. For example, in someembodiments, a target region is at the back of an organ and the deviceis inserted through an incision in front of the organ. As the device isintroduced, one or more part of the device bends around the organ, toaccess the target at the back of the organ, “hugging” the organ, forexample, the device contacting and/or encircling 10-100%, or 20-90%, or50-90%, or lower or higher or intermediate ranges or percentages of acircumference of the organ.

In some embodiments, bending of the device including one or more limbwithin the body is to access a target underneath (e.g. deeper within thebody) an obstacle, where a shortest straight line drawn between thetarget and the body surface (e.g. skin surface) passes through theobstacle. For example, in some embodiments, the ribcage is an obstacle(e.g. an obstacle to organs under the ribcage), and thoracic surgery isperformed by inserting a device through an abdominal incision. In anexemplary embodiment, the device inserted into the abdominal incisionfollows a path under the ribs, bending from a position under the ribs toaccess a target inside the ribcage.

In some embodiments, a mechanical device is inserted into a patient froma direction which is not substantially from above, for example, where anangle of insertion of the device with respect to the vertical is morethan 75°, or more than 90°, 75-175° (where angles of over 90° correspondto an angle of insertion from a direction underneath the patient whenthe patient is in a supine or prone position). In some embodiments, themechanical device is inserted into the patient laterally, for examplebetween the patient legs e.g. into a patient through a pelvic outlet.

In some embodiments, images guide a user performing the treatment. Forexample, images acquired by a camera inserted with the mechanicaldevice. In some embodiments, the camera is mounted on (e.g. at a distalend of) a bendable mechanical limb, where, for example, the camerastructure and/or flexibility is as described above for mechanical devicelimb/s. In some embodiments, images collected by other imaging methodse.g. MRI, CT, ultrasound etc. (e.g. previously acquired images) are usedto guide treatment.

An aspect of some embodiments of the invention relates to a method oftreatment where one or more mechanical device limb within a patient bodyfollows a long path, where a length of the limb within the body (e.g.measured a sum of long axis lengths of portions of the limb within thebody) is long in comparison to a distance between the target and pointof insertion of the device into the body, herein termed “entrancepoint”. In some embodiments, a length of a device limb within the bodyis at least 1.2 times, or at least 1.5 times, or at least double, or atleast triple, or at least quadruple times, or at least 5 times astraight line distance between the target and the entrance point. Apotential benefit of a long path is access to a wide range of desiredtargets for a given entrance point (e.g. incision). A potential benefitof a long path is the ability to insert the device at a wide range ofentrance points, for a given target.

In some embodiments, the device includes more than one limb, where thelimbs together access and treat a target. In an exemplary embodiment,the device includes two limbs, where, optionally, both limbs bend toaccess and treat a target.

A potential benefit of device bending within the body is the ability toinsert the device at a desirable entry point and/or at a desirableinsertion angle while treating a target from a desirable direction. Insome embodiments, a wide range of treatment angles (angle at which adevice limb approaches a target) are available for a given angle ofinsertion and/or for a given entrance point.

In some embodiments, treatment (e.g. surgery) is by accessing targetfrom a direction superior to the target, (e.g. as is usually the case inlaparoscopic surgery) while inserting of the device is through a naturalorifice located inferior of the target.

For example, in an exemplary embodiment, a device is inserted into abody through a vagina (incision is inferior of a uterus) and bendswithin the body to accesses a target region at the top (superiorportion) of a uterus, from an inferior direction (e.g. standardlaparoscopic direction e.g. a direction more directly impinging on atarget region than that a standard laparoscopic direction e.g. in asubstantially posterior-inferior direction). A potential benefit ofaccessing the uterus from an inferior direction through an incision inthe vagina is the ability to operate using of established laparoscopicsurgical techniques, but through an incision in the vagina, which ispotentially less invasive than an abdominal incision

In some embodiments, bending of the device occurs by bending of flexibledevice portions as the device is inserted into the body, e.g. a segmentbending as it is inserted and/or previously inserted segments bending assuccessive segments are inserted. In some embodiments, a straight deviceis inserted into the body and once the device is inserted it bends e.g.by actuation of the device portions and/or under friction between thedevice and patient tissue within the body. In some embodiments, a devicewith one or more folded portion is inserted into the body and bends tounfold.

An aspect of some embodiments of the invention relates to a method ofhysterectomy through the vagina. In some embodiments, a device isinserted through an incision made in the vagina. In an exemplaryembodiment, a device is inserted through an incision in the vaginaposterior fornix into the Pouch of Douglas. In some embodiments, one ormore portion of the device bends around the uterus to perform surgery onthe uterine area (e.g. uterus, vagina, cervix, tissue surrounding theuterus, fallopian tube/s, ovary/s). In some embodiments, one or moreportion of the device bends to access the uterus from the outside of theuterus, e.g. as device entrance through the posterior fornix is in adirection away from the uterus. In some embodiments, the device entersthe abdominal cavity at the base of the uterus, closer to the cervixthan the fundus and bends, to approach the uterus from an at leastpartially inferior direction and/or from a direction of a straight linefrom a point on an outer abdominal skin surface (e.g. umbilicus) to theuterus (e.g. a laparoscopic direction). In some embodiments, one or moredevice shoulder is positioned closer to the cervix than to the fundus.In some embodiments, one or more device shoulder is positioned closer tothe fundus than to the cervix.

In some embodiments, the incision in the posterior fornix is made usinga veress needle through which the abdominal cavity is then optionallyinflated. In some embodiments, the incision is enlarged and/or dilatedbefore insertion of the device. In some embodiments, the incision in theposterior fornix is made using a trocar.

In some embodiments, a port inserted into the vagina seals the abdominalcavity and/or provides support to the surgical device (e.g. insertedthrough the port) and/or to a uterus manipulator (e.g. inserted throughthe port).

Alternatively or additionally, in some embodiments, a port is placedinto the incision sealing the incision and/or providing support to thedevice. Optionally, the port is coupled to the cervix e.g. to providesupport to the port. Optionally, the port is coupled to a uterusmanipulator.

Optionally, a uterus manipulator is used in gynecological surgery (e.g.hysterectomy surgery). In some embodiments, a uterus manipulator issecured while allowing access to the vagina posterior fornix.Optionally, in some embodiments, the device supported by coupling to aport, the port, for example, coupled to the cervix. Optionally, a portis coupled to the uterus manipulator. A potential benefit of supportingthe device by a port coupled to the cervix is the ability to access theabdominal cavity through an incision in a thin tissue layer, where thelayer is, for example, unable to provide sufficient support to a port,(e.g. incision in the vagina posterior fornix).

In some embodiments, the abdominal cavity is inflated before incision ismade from the vaginal cavity in the Vagina posterior fornix. A potentialbenefit being, that, generally, inflation increases separation betweenorgans, potentially reducing the risk of incising causing damage toother tissue (e.g. rectum). In some embodiments, an incision isinitially made in the abdomen (e.g. umbilical incision), through whichthe abdomen is inflated (e.g. with carbon dioxide).

In some embodiments, inflation of the abdomen is made through aninternal incision in a fallopian tube. In some embodiments, a deviceincluding an inner cavity and a cutting edge is inserted from the uterusinto a fallopian tube. In some embodiments, the cutting edge puncturesthrough the fallopian tube to the abdominal cavity. The abdominal cavityis then inflated by gas inserted through the device inner cavity. Insome embodiments, the device including an inner cavity uses suction andpressure feedback, for example, as described above, when making theincision in the fallopian tube.

An aspect of some embodiments of the invention relates to a port whichis coupled to a portion of a patient body through which a deviceincluding a mechanical arm is inserted. In some embodiments, the port isinserted into and/or coupled to a natural orifice (e.g. the vagina). Insome embodiments, a uterus manipulator and/or other optional tools areinserted into the patient through the port. Potentially, the portprevents and/or reduces movement with respect to the patient of (e.g.supporting portions) of the tools inserted through it. Optionally, insome embodiments, the port is coupled to a portion of the system, forexample, a patient support surface.

In some embodiments, a treatment (e.g. hysterectomy) includes insertinga port into a natural orifice and/or coupling a port to a naturalorifice and then inserting one or more mechanical device limb into apatient through the port.

An aspect of some embodiments of the invention relates to making anincision where tissue is brought towards a cutting edge (e.g. tissue isbrought to an element comprising a cutting edge) for example, byincreasing pressure between tissue to be cut and a cutting edge (e.g.using suction). In some embodiments, once an incision is made, pressurebetween the cutting edge and tissue reduces preventing further cutting.In some embodiments, pressure is further reduced (e.g. by cessation ofapplied suction) once a measured reduction in pressure indicates that anincision has been made.

In some embodiments, a device for incision is sized and shaped such thatincreasing pressure between the a device end including a cutting edgeand body tissue to be cut brings the tissue into contact with thedevice.

For example, in some embodiments, an incision is made in the vaginaposterior fornix using a device including a cutting edge with a concaveportion (e.g. inlet and/or hollow and/or depression and/or cup-shape)sized such that the cervix fits into the concave portion and that anincrease in pressure in the depression brings the posterior fornix intocontact with an edge of the concave portion. In some embodiments, anedge of the concave portion includes an optionally sharp cutting edge.In some embodiments, the concave portion is placed over the cervix withthe sharp edged portion located at the vagina posterior fornix. The cupand/or tissue are brought together until the cutting edge makes anincision in the vagina posterior fornix. A potential benefit is controlover the position and/or extent of the incision (e.g. using a differentdepth concave portion and/or a different length cutting edge). In someembodiments, the tissue and concave portion are brought together bysuction. Optionally, reduction in suction pressure is used to ascertainthat an incision has successfully been made. A potential benefit ofusing suction is cutting with minimal force and/or control over thespeed and/or force of cutting, for example, reducing risk of damagingthe rectum.

In some embodiments, an incision is made in a fallopian tube by a deviceincluding a cutting edge inserted into the fallopian tube. In someembodiments, pressure between the cutting edge and fallopian tube isreduced, collapsing the tube bringing a portion of the tube into contactwith the cutting edge.

An aspect of some embodiments of the invention relates to protectinguser tissue, for example, by pushing and/or holding patient anatomy awayand/or shielding from a surgical zone. In some embodiments, a systemincluding mechanical arms (e.g. as described herein) includes aretractor tool (e.g. as described herein).

In some embodiments, the tool is mounted on a support and a deviceincluding mechanical arms is mounted on the support.

In some embodiment, the tool is extendable away from one or moremechanical arm (e.g. in one or more direction), where the tool extendsby expansion and/or is pushed (e.g. by a motor).

In some embodiments, mechanical device arm/s and the tool are actuatedby the same motor unit.

In some embodiments, the retractor tool is coupled to a mechanical armand/or a mechanical arm includes a retractor tool end effecter.

In some embodiments, a tool inserted into a patient includes anexpandable portion. In some embodiments, the tool is inserted, expanded,and used to push and/or hold user tissue away from portion/s of apatient body being operated on. For example, in some embodiments, thebowels are pushed away from the uterus by the tool e.g. during ahysterectomy. In some embodiments, the tool is inserted the samedirection of insertion and/or through the same incision as a deviceincluding mechanical arms.

In some embodiments, one or more mechanical limb is inserted at adifferent angle and/or inserted to a different depth and/or is insertedthrough a different incision. For example, assisting access to a targetby more than one mechanical limb, optionally from different directions.

In some embodiments, at least a portion of a surgical device mechanicallimb is covered with a cover, for example, a sterile cover e.g.providing a sterile separation between a device arm and the patient. Forexample, an electrically insulating cover.

In some embodiments, devices and/or systems and/or methods described inthis document are used in thoracic treatments (e.g. thyroidectomy).

In some embodiments, devices and/or systems and/or methods described inthis document are used in splenectomy.

In some embodiments, devices and/or systems and/or methods described inthis document are used in reproductive surgery (e.g. infertilitytreatment, sterilization).

In some embodiments, devices and/or systems and/or methods described inthis document are used in reconstructive pelvic surgery.

In some embodiments, treatment is performed on an abdominal target isperformed by inserting device arm/s into the abdomen e.g. through asurface abdominal incision and/or through the pelvic outlet (e.g.through a natural reproductive and/or excretory orifice) and bending thearms to approach a target.

In some embodiments, treatment is performed on a thoracic target byinserting one or more device arm under the rib cage from an incisionsuperior or inferior to the rib cage, where device arm/s are bent toaccess the target. In some embodiments, e.g. as described herein, one ormore device arm is inserted between adjacent ribs. In some embodiments,one or more device limb includes a chain of at least two rigid segmentscoupled by flexible connecting sections also herein termed “joints”. Insome embodiments, at least two rigid segments are long where, forexample, a long axis length of one or more long rigid segment is atleast 1.5 times, or at least double, or at least triple, or at least 5times, or at least 10 times, or intermediate values, a maximum extent ofthe segment perpendicular to said long axis. A potential benefit of longrigid portions, for example, in comparison to a larger number of shorterportions, is that movement and/or control errors are reduced e.g. asmovement and/or control errors are a sum of error movement for eachjoint.

In some embodiments, a proportion of a device and/or device limb longaxis length which is rigid (and/or formed by rigid segments) is high,for example 20% or more, 40% or more, than 60% or more, or 80% or more.In some embodiments, a proportion of a sum of rigid segment long axislengths is large in comparison to a total device and/or limb long axislength, for example 20% or more, 40% or more, than 60% or more, or 80%or more.

In some embodiments, a method of treatment includes inserting a deviceincluding one or more mechanical limb (e.g. as described herein) and oneor more laparoscopic tool. In some embodiments, a target issimultaneously and/or sequentially treated by one or more mechanicallimb and a laparoscopic tool.

Before explaining at least one embodiment of the invention in detail, itis to be understood that the invention is not necessarily limited in itsapplication to the details of construction and the arrangement of thecomponents and/or methods set forth in the following description and/orillustrated in the drawings and/or the Examples. The invention iscapable of other embodiments or of being practiced or carried out invarious ways.

Exemplary Device with Arms

Referring now to the drawings, FIG. 1A is a simplified schematic sideview of a device 100 (e.g. surgical device) including a plurality ofarms, according to some embodiments of the invention. In someembodiments, the device includes a first arm 104 and a second arm 102.

In some embodiments each arm 104, 106 includes a support segment 102,103, coupled to a first segment 112, 114 by a first connecting section108, 110, where first segment 112, 114 is coupled to a second segment116, 118 by a second connecting section 120, 122, and a third segment124, 126 coupled to second segment 116, 118 by a third connectingsection 128, 130.

In some embodiments, one or more of support segments 102, 103 are rigid.In some embodiments one or more of support segments 102, 103 areflexible or include a flexible portion

In some embodiments, support segments 102, 103 are coupled, e.g. by acover 102 a. In some embodiments, support segments are coupled at only aportion of the torso length or are not coupled: FIG. 1B is a simplifiedschematic of a device 100 including a plurality of arms 104, 106,according to some embodiments of the invention.

In some embodiments, one or more arm includes a humanoid like structure.For clarity, in some portions of this document, device segments andconnecting sections are referred to by anatomical names: Supportsegments 102, 103 are also termed first torso 102 and second torso,first connecting sections 108, 110 are also termed first shoulder joint108, second shoulder joint 110, first segments, 112, 114 are also termedfirst humerus 112 and second humerus 114, second connecting sections120, 122 are also termed first elbow joint 120, and second elbow joint122, second segments 116, 118 are also termed first radius 116 andsecond radius 118 and third segments 124 and 126 are also termed firsthand tool 124 and second hand tool 126.

In some embodiments, one or more connecting section includes a hinge. Insome embodiments, one or more connecting section is flexible and/orincludes a flexible portion. In an exemplary embodiment, for example, asdescribed in more detail below, a device arm includes an elbow joint anda shoulder joint where bending of the joint is distributed along thejoint in a direction of a joint long axis.

In some embodiments, torsos 102, 103 are close together, for example, along axis of first torso 102 and a long axis of second torso 103 arewithin 5 mm, or 3 mm, or 1 mm of each other.

In some embodiments, one or more device segment has a substantiallycylindrical external shape (e.g. radius, humerus). In some embodiments,joints have circular long axis cross-section. Alternatively, in someembodiments, one or more device segment and/or joint has non-circularcross section external shape, for example, oval, square, rectangular,irregular shapes.

In some embodiments, a mechanical arm includes one or more short and/oradjustable segment. In some embodiments, flexible portions are directlyconnected.

FIGS. 1C-1D are simplified schematic side views of mechanical arms,according to some embodiments of the invention. FIG. 1C illustrates anexemplary embodiment where a humerus segment 212 is short, for example,the segment including a long axis length, J of 1-50 mm, or 1-35 mm, or10-20 mm, or approximately 10 mm or lower or higher or intermediateranges or lengths.

In some embodiments, a user selects arm/s including desired segmentlengths, where for example, selection is based on patient anatomy and/ora procedure to be performed. For example, when treating a child a user,in some embodiments, selects one or more arm with one or more shortsegment (e.g. as illustrated by FIG. 1C). For example, when treating anobese patient, a user, in some embodiments, selects an arm with one ormore a long segment for example, a standard arm with a long humerussegment (e.g. as illustrated by FIG. 1D) (e.g. humerus segment length,J′ is 10-100 mm, or 20-35 mm, or 10-20 mm, or lower or higher orintermediate ranges or lengths).

In some embodiments, a device includes a kit with different structuredarms (e.g. different segment lengths, e.g. different arm sizes).

Alternatively or additionally, in some embodiments, one or more segmentlength is adjustable, e.g. during a treatment and/or during set-up ofthe device. For example, in some embodiments, the arm illustrated inFIG. 1C is adjustable (e.g. by telescoping of humerus segment 212) isadjustable to the configuration illustrated in FIG. 1D.

In some embodiments, extension and/or retraction of one or more segmentis effected by a portion connected to the segment (e.g. a segmentextension) being moved with respect to other potions of a mechanicalarm. For example, in some embodiments, a segment extension (e.g.extension 3316E FIG. 33B) is moved (e.g. by a motor located in a motorunit e.g. motor unit 4000 FIG. 40) to increase a length of a segment(e.g. segment 3316 FIG. 33B). In some embodiments, a motor uses a screwmechanism to move the segment extension (for example, a screw mechanismsimilar to a screw mechanism for actuating a gripper e.g. as describedregarding FIG. 36A-36B).

Exemplary Freedom of Movement, Exemplary Human Freedom of Movement

In some embodiments, a device limb has at least the freedom of movementof human arms. Generally, segments of human limbs (e.g. arms, legs) moveby flexion and extension from a proximal segment joint, and rotationaround the proximal segment joint. For example, a human radius flexesand extends at the elbow and rotates around the elbow.

The term proximal joint herein refers to the joint which is leastremoved from the torso to which a segment is coupled, e.g. a handproximal joint is the wrist, a radius proximal joint is the elbow joint,a humerus proximal joint is the shoulder joint.

The term proximal segment herein refers to the segment which is leastremoved from the torso to which a segment is coupled (e.g. by a proximalsegment joint). For example, a hand proximal segment is the radius, aradius proximal segment is the humerus, a humerus proximal segment isthe torso.

In some embodiments, one or more joint is uni-directionally bendable andextendable. In some embodiments, segment rotation around a segmentproximal joint is achieved by rotation of a proximal segment around aproximal segment long axis. For example, rotation of the hand around thewrist joint is by rotation of the radius around a radius long axis.

Generally, human freedom of movement for arms includes limits to theangles of rotation and flexion. Optionally, in some embodiments, thedevice is restricted to human freedom of movements e.g. during one ormore control mode.

FIG. 2A is a simplified schematic side view of a mechanical arm 204,according to some embodiments of the invention.

In some embodiments, each segment of arm 204 is rotatable around asegment long axis. For example, in some embodiments, torso 202 isrotatable 202R around a torso long axis 202L. For example, in someembodiments, humerus 212 is rotatable 212R around a humerus long axis212L. For example, in some embodiments, radius 216 is rotatable 216Raround radius long axis 216L.

FIG. 3 is a simplified schematic side view of a hand segment 324,according to some embodiments of the invention. In some embodiments,hand segment 324 is rotatable around a hand long axis.

In some embodiments, one or more segment is rotatable in both directions(e.g. clockwise and anticlockwise around the segment long axis).Alternatively, in some embodiments one or more segment is rotatableabout a segment long axis in one direction only.

Referring back to FIG. 2A, in some embodiments, for example, analogousto human ability to stand and/or crouch and/or jump, the device ismovable 232 in a direction parallel to torso long axis 202L.

In some embodiments, each segment flexes and extends at a segmentproximal joint. For example, in some embodiments, radius 216 flexes andextends at elbow joint 220. For example, in some embodiments, humerus212 flexes and extends at shoulder joint 208. Referring to FIG. 3, forexample, in some embodiments, hand tool 324 is flexes and extends atwrist 328.

In some embodiments, flexion and extension of a segment at a joint ismeasured as an angle through which the joint bends. In some embodiments,flexion and extension of a segment is measured as an angle between along axis of the flexed segment and a long axis of a proximal segment tothe flexed segment. For example, the angle between a flexed radius longaxis and a humerus long axis.

In an exemplary embodiment, flexible portions (e.g. elbow joint 220,humerus 212) bend uniformly, for example, where bending a radius ofcurvature is constant along the flexible portion when the portion isbent. In some embodiments, one or more flexible portion includessub-portion/s with different radiuses of curvature (e.g. where a stackof a plurality of links forming a flexible portion is composed of linkswith different dimension/s (e.g. different lengths) and/or gaps (e.g.gaps 2799 FIG. 27) between links have different dimensions.

FIG. 2B is a simplified schematic of two segments 212, 216 connected bya joint 220, according to some embodiments of the invention. FIG. 2Billustrates measurement of flexion of segment 216 as an angle, θ,between a first segment long axis 216L and a second segment long axis212L.

In some embodiments, θ is more than 180°, due to, for example,sufficient joint length (e.g. length of a long axis of the joint islonger than double combined diameter/cross sectional maximum extent ofboth segments) and ability of the joint to flex and/or extend.

FIG. 2C shows illustrations of possible limb positions, and/or movementof a device with time, according to some embodiments of the invention.FIG. 2C shows potential flexibility of an exemplary device limbincluding exemplary angles of bending of joints of 180° and more.

Referring back to FIG. 2A, in some embodiments, humerus 212 flexes andextends 209 at shoulder joint 208 (also herein termed shoulder flexion),by up to at least 45°, or by up to at least 90°, or by up to at least180°. In some embodiments, shoulder flexion is more than 180°. In someembodiments, shoulder flexion is up to 250°, or up to 300°. In anexemplary embodiment, shoulder flexion is about 200°.

In some embodiments, radius 216 flexes and extends from elbow joint 220(also herein termed elbow flexion), by up to at least 45°, or by up toat least 90°, or by up to at least 180°. In some embodiments, elbowflexion is more than 180°. In some embodiments, elbow flexion is up to250°, or up to 300°. In an exemplary embodiment, elbow flexion isapproximately 200°.

Referring now to FIG. 3, in some embodiments, a hand segment 324 (e.g.hand tool) flexes and extends 329 b at wrist joint 328. In someembodiments hand segment 324 is rotatable around the wrist joint in aplane perpendicular to radius long axis 329 a (e.g. in a plane includingscissor blades 325 a, 325 b), for example, in movement corresponding tohuman radial and/or ulnar deviation. In some embodiments, flexing andextending of hand segment 324 is about an axis 329 b perpendicular to along axis of the radius 316L. In some embodiments, radial and ulnardeviation is about an axis 329 c.

In some embodiments, hand segment 224, 324 flexes and extends from wristjoint 228, 328 (also herein termed wrist flexion), by up to at least45°, or by up to at least 60°, or by up to at least 90°, or by up to atleast 180°. In an exemplary embodiment wrist flexion is 90° (e.g. ±45°).

In some embodiments, a mechanical arm includes less structuralcomplexity (e.g. less portions) and/or less freedom of movement thanthat of human arms.

For example, in some embodiments, a mechanical arm does not include awrist joint. For example, in some embodiments, flexion and extension ofan end effecter is controlled by a flexible section corresponding to anelbow joint. For example, in some embodiments, an end effecter iscoupled to a rigid portion (e.g. corresponding to a radius) and theflexion of both the end effecter and the rigid portion is controlled bya flexible section connected to the rigid portion.

Referring now back to FIG. 1C, in some embodiments, a mechanical arm 104c includes an end effecter 124 coupled to a second segment 116 where thecoupling is a rigid coupling (e.g. without a third connecting section,e.g. without a wrist joint). In some embodiments, mechanical arm 104 cincludes a support segment 102 coupled to a flexible first portion 108,where flexible first portion 108 is coupled to a flexible second portion116.

In some embodiments, end effecter 124 and second segment 116 are onepiece and/or are rigidly connected.

In some embodiments, end effecter 124 is rotatable independently ofsecond segment 116, e.g. end effecter 124 is rotatable around an endeffecter long axis 124L.

In some embodiments, hand segment (e.g. 124, 126, FIG. 1A and FIG. 1B,224 FIG. 2A, 324 FIG. 3) includes a hand tool. In some embodiments, ahand tool includes a scissors (e.g. 124 FIG. 1A, 224 FIG. 2A, 324 FIG.3). Hand tools are described in more detail below.

In some embodiments, a device includes at least two flexible portions,where each flexible portion is bendable by at least 120°. In someembodiments, two flexible portions are bendable together by up to 180°.In some embodiments, two flexible portions are bendable together by morethan 180°. In some embodiments, each of one or two or more deviceflexible portion is bendable by 180° or more. In an exemplaryembodiment, combined flexions provide a total bending of the device of360° or more. For example, device joints are bent such that the deviceforms a circle and/or coil in space, e.g. as illustrated by FIG. 2C.

In some embodiments, one or more arm segment is able to move with morethan human freedom of movement: For example, in an exemplary embodiment,humerus rotation about a humerus long axis and/or radius rotation abouta radius long axis and/or hand rotation about a humerus long axis.

Exemplary Device Flexibility

In some embodiments, the device, e.g. within a patient, is highlyflexible. A potential benefit being, for example, flexibility of pathand/or movement of the device within a patient (e.g. reducing tissuedamage) and/or the ability to perform surgical procedures in a desiredway (e.g. position of incisions, angle from which incisions are made).

As described previously, in some embodiments, the angle of each segment(and/or effective segment) with respect to adjacent segments isadjustable e.g. by flexion/extension of segments around coupling joints.Optionally, each segment is flexible/extendable and rotatable around asegment proximal joint.

In some embodiments, for one or more segment, segment flexion is up to180° or more, and the segment is rotatable by up to 180° or more about aproximal segment joint: In some embodiments, possible positions of asegment distal end form a cylinder around the segment proximal joint. Apotential benefit being a wide range of possible positions of the devicein space.

Exemplary Distance of Hands to Torso, Angle Between Arm Radiuses

In some embodiments, the device is flexible such that, positions of oneor more hand of a device and/or one or more distal end of a radius of adevice are locatable substantially at the torso and/or shoulder joint.In some embodiments, more than one hand and/or distal end of radiusesare locatable substantially at the torso and/or shoulder joint whentorsos are close together (e.g. within 10 mm, within 5 mm, or 3 mm, or 1mm of each other) and optionally. A potential benefit being the abilityto access a target (e.g. with one or more hand tool) close to the torso.

In some embodiments, separation between a distal end of the radius andthe shoulder joint is reducible to 40%, or 20%, or 10%, or 5%, or 1%, ofa length of the humerus or radius. In some embodiments separationbetween a distal end of the radius and the torso is reducible to 40%, or20%, or 10%, or 5%, or 1%, of a length of the humerus or radius.

In some embodiments, an angle (herein “radius angle”) between a firstarm radius long axis and a second arm radius long axis is adjustablebetween substantially zero (arms are held out parallel, forwards of thetorso), through intermediate angles, for example where hands are forwardof the torso and together, and up to 180°, for example, where elbows areoutward and hands are together.

A potential benefit of parallel radiuses (and other low radius anglese.g. less than 20°) is the ability of the device to interact (e.g.operate) on an area with restricted access e.g. in some embodiments, thedevice accesses a target through a narrow passage. A potential benefitof larger angles between arm radiuses (e.g. over 45°), is the abilityfor the arms (e.g. arm hands) to access a target close to the torso.

Exemplary Long Device

In some embodiments, a potential length of a device (e.g. a lengthincluding a hand axial length, a radius axial length, a humerus axiallength and a torso axial length) within a body is long.

In some embodiments, a potential length of a device within a human bodywith respect to a deepest extent of the device within a human body islong. In some embodiments, a length of the humerus segment is 20-100 mm,or 40-80 mm, or 50-70 mm, or about 60 mm. In some embodiments, a lengthof the radius segment is 10-90 mm, or 20-70 mm, or 30-60 mm, or about 50mm.

For example, in some embodiments, an ability of the device to bendand/or fold means that the device travels a long path within a patient'sbody, optionally, in comparison to a maximum depth of insertion into abody (maximum depth e.g. measured as the longest straight path from askin surface and/or an incision site to a potion of the device).

Exemplary Long Joints

In some embodiments, one or more joint is long in an axial direction.For example, in some embodiments, a joint is long with respect to one ormore segment length. For example, in some embodiments, a joint is longwith respect to one or more segment maximum cross sectional dimension(e.g. segment diameter).

In some embodiments, device joints are long with respect to humananatomy joint lengths (e.g. with respect to segment lengths and/ordiameters).

In some embodiments, a joint long axis length is at least 1.5 times, or2 times, or 3 times, or 5 times a maximum cross sectional extent of thejoint (e.g. diameter of the joint).

A potential benefit of a long joint is increased possible flexion and/orextension, for example, in some embodiments, a long joint means that,flexion and/or extension is not prevented by segments coming intocontact with each other.

A potential benefit of a device including one or more long joints (e.g.as opposed to a device with pivot joints and/or hinges) is the abilityto bend the device with a smaller lateral extent of the device. Afurther potential benefit is a rounder and/or less sharp curve of thejoint, for example, potentially less invasive and/or damaging to tissue.For example, referring to FIG. 5A, long joints and/or joints with alarge radius of curvature (e.g. in some embodiments, a minimum radius ofcurvature of a joint is 2-15 mm, or 4-12 mm, or 6-10 mm or intermediatevalues) have a small lateral extent. For example, a small lateral extentis associated with a length, L, between a midpoint of a long joint andan intersection of effective segment long axes being 5-50%, or 10-40%,or lower or higher or intermediated ranges or percentages, of aneffective length of a limb distal to the joint (e.g. of limb length B′),for example, when the joint is bent by 45° or more.

Exemplary Structure, Dimensions

In some embodiments, a torso thickness (e.g. diameter) and/or a shoulderjoint thickness (e.g. diameter) is 1 mm-20 mm, or 3 mm-15 mm, or 5 mm-10mm or intermediate values. In an exemplary embodiment, a torso diameterand/or a shoulder joint diameter is about 8 mm.

In some embodiments, a humerus thickness (e.g. diameter) and/or an elbowjoint thickness (e.g. diameter) is 1 mm-15 mm, or 2 mm-10 mm, or 4 mm-8mm or intermediate values. In an exemplary embodiment, a humerusthickness (e.g. diameter) and/or an elbow joint thickness (e.g.diameter) is about 6 mm. In some embodiments, a radius thickness (e.g.diameter) and/or a shoulder joint thickness (e.g. diameter) is 0.5 mm-10mm, or 1 mm-6 mm, or 3 mm-4 mm or intermediate values. In an exemplaryembodiment, a radius thickness (e.g. diameter) and/or a wrist jointthickness (e.g. diameter) is about 3-4 mm.

In some embodiments, a central long axis length of the humerus segmentis 20-100 mm, or 40-80 mm, or 50-70 mm, or about 60 mm or intermediatevalues. In some embodiments, a central long axis length of the radiussegment is 10-90 mm, or 20-70 mm, or 30-60 mm, or intermediate values orabout 50 mm.

In some embodiments, a minimum radius of curvature of a joint is 2-15mm, or 4-12 mm, or 6-10 mm or intermediate values.

In an exemplary embodiment, a minimum radius of curvature of a joint isabout 10 mm. In an additional exemplary embodiment, a minimum radius ofcurvature of a joint is 6 mm.

In some embodiments, one or more segment is thin. In some embodiments, athin segment has a maximum extent perpendicular to a segment long axisof about 20% of a long axis length or less, or 10% of the long axislength or less, or 8% of the long axis length or less or 6% of the longaxis length or less or intermediate values. A potential benefit of athin device is reduced invasiveness of the device within a body, forexample, the device displaces and/or damages less tissue than a widerdevice of the same length.

FIG. 4B is a simplified schematic side view of a mechanical arm 404,according to some embodiments of the invention. In an exemplaryembodiment,

In some embodiments, a support segment and a shoulder joint have aboutthe same thickness and/or cross sectional shape and/or dimension/s. Insome embodiments, a shoulder joint and humerus segment have about thesame thickness and/or cross sectional shape and/or dimension/s. In someembodiments, an elbow joint and a radius segment have about the samethickness and/or cross sectional shape and/or dimension/s.

In some embodiments, a thickness of an elbow joint and/or a radiussegment, (e.g. dimension C FIG. 4B) is 1-20 mm, or 3-15 mm, or 7-11 mm,or about 9 mm, or lower or higher or intermediate ranges or thicknesses.In an exemplary embodiment, dimension C is 9 mm.

In an exemplary embodiment, a support segment thickness (e.g. diameter),dimension D, is 8 mm.

In some embodiments, a central long axis length E of a portion of themechanical arm including a shoulder joint, a humerus segment, a elbowjoint, and a radius segment including a length of an end effecter is50-200 mm, or 80-150 mm, or 90-120 mm, or about 110 mm, or lower orhigher or intermediate ranges or lengths. In an exemplary embodimentlength E is 111.7 mm.

In some embodiments, two support segments (torso segments) of a deviceincluding two or more mechanical limbs are configured (e.g. attached toa base) such that a long axes of the limb support segments aresubstantially parallel (e.g. within 5° or 10°, or 20° of parallel). Insome embodiments, long axes of the limb support segments are configuredat different directions.

Exemplary Structural Differences and Similarities to Human Arms

In some embodiments, two or more segments have length ratios similar tohuman segment length ratios. FIG. 4A is a simplified schematic side viewof a device 400 where device humanoid proportions are illustrated bycomparison to a simplified schematic of a human upper body 401,according to some embodiments of the invention. In some embodiments aratio between two dimensions of a device and/or an arm is substantiallysimilar to an equivalent average human ratio. For example, in someembodiments, a humerus segment central long axis length is about 20%longer than a radius segment central long axis length. In someembodiments, a humerus segment long axis length is about 15% longer orabout 25% longer than a radius length.

In some embodiments, an effective segment length is measured along acentral long axis between mid-points of flexible sections, or, if thesegment is the most distal segment, along a central long axis between adistal end of the segment and a mid-point of the flexible sectionattaching a proximal end of the segment to the arm.

In some embodiments, the device lacks one or more segment (e.g. iscomposed entirely of flexible portions). In some embodiments, effectivesegment length, in some embodiments, is measured along a central longaxis (or, in some embodiments as the length of a straight line) betweenflexible portion midpoints. In some embodiments, for the most distalflexible portion, an effective segment length is measured along acentral long axis (or, in some embodiments as the length of a straightline) between a distal end of the most distal flexible portion to amidpoint of the flexible portion coupled to a proximal end of the mostdistal flexible portion.

In some embodiments, effective segment length is measured as a length ofa straight line between intersections of extensions of axes tangentialto long axes at centre points of adjacent segments (or, where there isno segment, extensions of axes tangential to long axes of flexibleportions where flexible portions connect). Where an effective segmentlength of the most distal effective segment, in some embodiments, ismeasured as a length of a straight line between intersections of a longaxis extension of an axis tangential to a long axis at a center point ofan adjacent segment (or, where there is no segment, a extension of anaxis tangential to a long axis of the flexible portions where flexibleportions connect) to a distal end of the most distal segment (or, wherethere is no most distal segment, the device distally terminating in aflexible portion and/or end effecter, to a distal end of the most distalflexible portion).

In some embodiments, one or more segment effective length ratio is aboutthe same as an average humanoid segment length ratio. For example,referring back to FIG. 4B, in some embodiments, an effective radiuslength is A and an effective humerus length is B where the ratio of longaxis lengths A to B is about that of a human radius to humerus lengths(e.g. about 1:1.2).

In some embodiments, when a device arm is in different configurations,for example, different extents of bending of the different flexibleportions, one or more effective segment length ratio remains within arange which is similar to that of the corresponding human segment ratio.

FIG. 5A shows illustrations of possible device positions, and/ormovement of a device with time, according to some embodiments of theinvention. For example, arm configuration 504 shows a configurationwhere effective segment lengths, A′, B′ are both increased from theirlengths when the device arm is straight. Effective segment lengths aremeasured from intersections between extended central long axis of acentral portion of the segment and, in the case of the most distalsegment (e.g. effective length A′), from the distal end of the segmentto an intersection.

In some embodiments, increasing bending at the joints, increasesindividual effective segment lengths. For example, effective length B″is less than that of effective length B′. However, ratios betweeneffective lengths, for example between effective humerus and radiuslength is changed most from the ratio when the arm is in a straightposition where one joint is bent and another joint is straight. Forexample, when a device arm is bent at the shoulder joint and straight atthe elbow joint, the humerus effective length is increased from thehumerus length when the arm is in a straight position, whereas theradius effective length is unchanged from when the arm is in a straightposition.

FIGS. 5B-5D are simplified schematic side views of a mechanical arm,according to some embodiments of the invention.

Alternatively, effective limbs are considered to be the straight linesconnecting the center points (longitudinal and/or radial) of flexiblesections. FIG. 5B and FIG. 5C show effective limbs, where an effectivefirst segment, with length C′ is the straight line connecting shouldermidpoint 591 and elbow midpoint 593 and an effective second segment withlength D′ is the straight line connecting wrist midpoint 595 and elbowmidpoint 593.

In an exemplary embodiment, length A (FIG. 4B) is 36.2 mm and length Bis 44 mm (FIG. 4B). In an exemplary embodiment, length C′ (FIG. 5B) is48 mm, length D′ (FIG. 5B) is 40 mm, length C″ (FIG. 5B) is 44 mm andlength D″ (FIG. 5B) is 36.6 mm and a ratio of effective first segmentlength to effective second segment length remains about the same, atabout 1.2 (e.g. for different angles of bending of the elbow joint whenthe shoulder joint remains stationary).

Alternatively, effective limbs are considered to be measured along thecentral longitudinal long axes of portions of the arm, where the firstsegment effective length is measured along a longitudinal long axismeasured from a wrist midpoint to an elbow midpoint (e.g. length E+Fillustrated in FIG. 5D) and the second segment effective length ismeasured along a longitudinal long axis measured from a wrist midpointto an elbow midpoint (e.g. length G+H illustrated in FIG. 5D). Where inan exemplary embodiment, length E is 31.3 mm, length F is 18.3 mm,length G is 18.3 mm, and length H is 23 mm.

Referring back now to FIG. 4A, in some embodiments, the device isthinner than human anatomy. For example, in some embodiments, a ratio ofa device segment axial length with respect to a maximum device segmentcross sectional area is larger than an average human anatomy ratio e.g.more than 1.5 times, or more than 2 times, or more than 4 times, or morethan 10 times.

A potential benefit of a thin device is the ability to approach aninternal body target by displacing tissue minimally and/or with minimumdamage to tissue. For example, in some embodiments, an incision sizerequired for insertion of the device is small. In some embodiments, adevice includes one arm and an incision size is or less than 17 mm, orless than 15 mm, or less than 10 mm, or about 8 mm. In some embodiments,a device includes more than one arm and an incision size is or less than30 mm, or less than 20 mm, or about 16 mm.

In some embodiments, the device has narrower shoulder with respect todevice segment lengths, than an average human shoulder e.g. a maximumdevice shoulder as measured between first arm end of the humerusproximal to the first torso and a second arm end of the humerus proximalto the second torso is less than with respect to a humerus length isless than 75% of an average human ratio, or less than 50%, or less than25%.

In some embodiments a torso length, for example, with respect to one ormore arm segment length, is longer than that of a human torso length. Apotential benefit of a long torso is the ability to insert the deviceinto a patient to a wide range of required depths.

Exemplary Arm Configurations

In some embodiments, arms have different geometries and/or features. Forexample, in some embodiments, different arms have different hand tools:Referring back to FIG. 1A, first arm 104 has a scissors hand tool 124and second arm 106 has a gripper hand tool 126. Hand tools will bedescribed in more detail below.

In some embodiments, different arms have different segment and/or jointgeometry. FIG. 6 is a simplified schematic side view of a deviceincluding a plurality of arms, according to some embodiments of theinvention. In some embodiments, a first arm 604 has a longer shoulderjoint 608 than a second arm shoulder joint 610. Optionally, in someembodiments, segment dimensions and/or hinge dimensions, and/or freedomof movement are different for different arms.

Exemplary Number of Arms

In some embodiments, the device includes two arms. In some embodiments,the device includes one arm. In some embodiments, the device includesmore than two arms. FIG. 7 is a simplified schematic side view of adevice 700 including more than two arms, according to some embodimentsof the invention. In some embodiments, device 700 includes a first arm704, a second 706 arm and a third arm 705.

Optionally, one or more arm has a different hand tool. In someembodiments, first arm 704 has a scissors hand tool 724 and second arm706 and third arm 705 have gripper hand tools 726, 725. Hand tools aredescribed below in more detail.

Optionally, two or more torsos are coupled to each other.

In some embodiments, one or more device mechanical limb is larger thanone or more other limb. In some embodiments, a device includes threemechanical arms and with a first and second arm with about the samedimensions e.g. segment long axis lengths and/or joint long axis lengthsand/or maximum segment extent perpendicular to a segment long axisand/or maximum joint extent perpendicular to a joint long axis. In anexemplary embodiment, a third arm is larger than a first and second arm.

In some embodiments a larger arm has one or more portion dimension(where dimensions include segment long axis, joint long axis, segmentmaximum extent perpendicular to the segment long axis and joint maximumextent perpendicular to the joint long axis) 1.5 times larger, or 2times larger, or 5 times larger, or 10 time larger, than a correspondingfirst and/or second arm segment dimension. A potential benefit of alarger arm being, for example, the ability of the arm to apply moreforce (e.g. to tissue) and/or the ability of the arm to contact a largersurface area of tissue.

In some embodiments, a larger arm (e.g. a larger third arm) includesadditional elongated elements for control of movement of the arm (e.g.as described below). For example, in some embodiments, a larger armincludes two elongated elements, or more than two elongated elements, orfour elongated elements. In some embodiments, a third arm includes fewerjoints than a first and second arm. In some embodiments, a third arm isused to hold and/or push and/or reposition patient anatomy, for example,to provide access to and/or increase tension on a target area.

In some embodiments, a third arm is controlled by mimicking of legmovement. In some embodiments, a third arm is controlled by mimicking ofmovement of a first user leg and a fourth arm is controlled by mimickingof movement of a second user leg.

Exemplary Additional Tools

Optionally, in some embodiments, device 700 includes one or moreadditional component, where the component is, for example, coupled to amechanical limb. In some embodiments, the component is inserted into thebody, optionally into the same incision as one or more mechanical devicelimb e.g. the component is an additional tool.

In some embodiments, device 700 includes a service tunnel 740. In someembodiments, service tunnel is formed by an opening and a hollow portionwithin a device arm. In some embodiments, service tunnel is a separatecomponent. In some embodiments, service tunnel 740 provides access tothe site of the arms for example, for transfer of suturing wires.

In some embodiments, device 700 includes a tube 742 for suction and/orirrigation. Optionally, tube 742 is inserted through service tunnel 740.In some embodiments, suction tube is used to extract fluid duringsurgery, e.g. blood, as is known in the art of surgery.

In some embodiments, the device includes one or more imaging device(e.g. camera, ultrasound device), for example, for providing images fromwithin the patient. Internal cameras are described in more detail below.

In some embodiments, the device includes one or more sensor, forexample, to provide information as to conditions within the deviceand/or inside the patient e.g. a temperature sensor, a motion sensor, apressure sensor. In some embodiments, one or more pressure sensor isused to provide force feedback to a user.

In some embodiments, torsos and optionally additional tools and arepositioned and/or coupled close together e.g. within 20 mm, or 10 mm, or5 mm of each other, a potential benefit being insertion of the deviceinto a small incision and/or small natural orifice.

In some embodiments, an additional tool is used to hold and/or push usertissue e.g. to hold tissue away for cutting, to provide tension totissue to be cut. Optionally, a hand tool for holding tissue includes anexpanding portion the surface of which can be expanded by one or moreportion unfolding and/or inflating and/or sliding past other portions(e.g. fan-like construction).

Exemplary System

In some embodiments, a device including a plurality of arms is part of asurgical and/or treatment system. FIG. 8 is a simplified schematic blockdiagram of a system, 850 according to some embodiments of the invention.

In some embodiments, the system includes a user control 852 throughwhich a user directs a device 800 including a plurality of arms.

In some embodiments, device 800 includes one or more imaging device 856.

In some embodiments, device 800 includes a device controller 855, forexample motors (e.g. for controlling movement of arm segments).

Optionally, one or more part of device control is external to thedevice. Optionally, one or more part of device control is manual, forexample, where a user directly controls movement (e.g. by insertingand/or extracting the device into a body, e.g. by pulling one or moreelongated element, e.g. by rotating one or more segment extension).

In some embodiments, system 850 includes one or more imaging device 858,for example an external imaging device e.g. ultrasound.

In some embodiments, the system includes a display 854, for example toshow information and/or images to the user.

In some embodiments, system 850 includes a database 860, for example forstoring of images collected by imaging devices 856, 858.

Optionally, system 850 includes one or more processing application. Insome embodiments, device control is automatic, where a processingapplication, for example, controls motor and/or actuator movement.

In some embodiments, one or more of imaging device 856 and/or imagingdevice 858 and/or database 860 and/or display 854 include a processingapplication. In some embodiments, a single processing applicationcontrols more than one system element. For example, in some embodiments,user control 852 and display 854 are part of a single unit (e.g.computer and/or touch-screen).

In some embodiments, one or more part of system 850 are in differentlocations. For example, in some embodiments, device 800 is in a firstlocation and user control 852 and display 854 are in a second location.For example, facilitating a patient being operated by a surgeon in adifferent location e.g. in a different room and/or a number of km away.

Exemplary Imaging and Display Exemplary Device Including Imaging Device

Optionally, in some embodiments, device includes one or more imagingdevice (e.g. camera, endoscope, ultrasound etc.), which is optionallyinserted with the device including one or more mechanical limb into thepatient. In an exemplary embodiment, the imaging device is a camera.

In some embodiments, positioning of the camera with respect to devicelimbs is about that of average positioning of a human head tocorresponding human arms.

For example, in some embodiments, a ratio between a distance of thecamera to one or more portion of a mechanical arm is about the same as aratio of one or more portion of the device to an equivalent human bodyportion.

In some embodiments, the camera is positioned at the same positionrelative to the device arms and/or hands as human eyes are from humanarms and/or hands, e.g. the camera is at located the corresponding (e.g.scaled) length of the humerus above the shoulder joint.

In some embodiments, the camera is positioned such that images have afield of view (FOV) and/or angle of the device portion/s as human eyeshave of corresponding user body portion/s. A potential benefit beingthat the camera provides an intuitive view of the device assisting usercontrol using user body movement.

FIG. 9A is a simplified schematic of a device 900 including a pluralityof arms 904, 906 and a camera 978, according to some embodiments of theinvention. FIG. 9B is a simplified schematic of a device 900 including aplurality of arms 904, 906 and a camera 978, according to someembodiments of the invention.

In some embodiments, a position of camera 978 with relation to arms isadjustable. For example, as illustrated in FIG. 9B in some embodiments,camera 978 moves, for example, closer to hand tools 924, 926, e.g. toprovide detailed images for close work. Such movement is analogous tonatural human positioning for close work, where often, the hands andhead are brought close together for fine work. Optionally, the usercontrols the position of the camera. In some embodiments, user headand/or neck position and/or movement is measured and used to control thecamera.

In some embodiments, an imaging device (e.g. camera) bends, for example,with one or more device joint. FIG. 9C is a simplified schematic of adevice 900 including a plurality of arms 904, 906, and a camera 978 bentat a device shoulder joint, according to some embodiments of theinvention.

FIG. 9D is a simplified schematic of a device 900 including a pluralityof arms 904, 906, and a camera 978 bent at a device shoulder joint,according to some embodiments of the invention. As illustrated in FIG.9D, in some embodiments, the bent imaging device is movable, forexample, with respect to the device arms.

In some embodiments, a mechanical arm (e.g. with structure as describedelsewhere in this document) includes a camera. For example, in someembodiments, a mechanical arm end effecter and/or third segment includesone or more camera. For example, in some embodiments, a mechanical armincludes a structure with more than one flexible section connected bymore than one rigid section, where a camera is disposed on the arm (e.g.at a distal end of the arm).

As mentioned elsewhere in this document (e.g. regarding FIG. 7) in someembodiments, one or more arm includes fewer joints than a first andsecond arm.

FIG. 10A is a simplified schematic side view of a device 1000 includinga mechanical arm 1005 which includes a camera 1078, according to someembodiments of the invention. In some embodiments, mechanical arm 1005includes a support section 1002 connected by a first flexible section1010 to camera 1078. In some embodiments, camera 1078 is disposed at adistal end of arm 1005.

In some embodiments, movement of a mechanical arm including a camera iscontrolled by measured movement of a user's head. For example, bymovement of a user's head in space and/or by movement of a user's headwith respect to one or other body part (e.g. torso and/or neck).

In some embodiments, movement of a mechanical arm including a camera iscontrolled by measured movement of a user's limb (e.g. arm). Forexample, the arm includes at least a first and a second flexible portion(e.g. as described elsewhere in this document), the movement of which iscontrolled by a user shoulder and elbow joint respectively).

Additionally or alternatively, in some embodiments, movement of amechanical arm including a camera is controlled by movement of portion/sof an input device (e.g. as described elsewhere in this document).

Additionally or alternatively, in some embodiments, a position of one ormore tool inserted into a patient body (e.g. a camera, e.g. a mechanicalarm, e.g. tube 742 FIG. 7) is controlled by one or more device arm. Forexample, in some embodiments, a tool is grasped by one or more devicearm and moved into a desired position. For example, in some embodiments,a tool (e.g. a camera e.g. camera 1378 FIG. 13) includes an elasticallydeformable portion such that, upon positioning of the tool the toolremains in position until the tool is repositioned. For example, in someembodiments, a suction tube (e.g. tube 742 FIG. 7) is positioned by asurgical arm moving the tube. In some embodiments, a tool (e.g. a tubee.g. tube 742 FIG. 7) includes one or more elastically deformableportion, such that, for example, the tool is moved into a desiredposition by a movement of a mechanical device arm, returning towards anoriginal position once the tool is released.

Exemplary External Imaging Device

Referring back now to FIG. 8, optionally, in some embodiments, thesystem includes an imaging device 858 separate to device 800. In someembodiments, imaging device 858 provides real time imaging when device800 is moving within the patient (e.g. conducting surgery). For example,in some embodiments, an external ultrasound is used for example, toprovide images of device 800 inside the body.

In some embodiments, imaging device 858 (e.g. MRI, CT, nuclear imaging,ultrasound etc.) collects images before insertion of device 800, forexample, to provide an anatomic map to aid surgery. In some embodiments,imaging device 858 provides images during use of device 800 within thebody and/or after the device is removed.

Exemplary Display

In some embodiments, images are displayed, (e.g. to a user). Forexample, in some embodiments, images from an internal imaging device aredisplayed to provide feedback as to a position of the device within thepatient. Referring back to FIG. 8, in some embodiments, one or moreimage is displayed on display 854 to a user.

In some embodiments, display 854 is a screen (e.g. computer monitor)visible to the user. In some embodiments, display 864 is part of avirtual reality (VR) environment, e.g. display 864 is one or more screeninside a VR visor.

Exemplary Displayed Images

In some embodiments, display 854 shows images of device 800 within apatient. In some embodiments, images are provided by one or moreinternal camera where the camera is, for example, inserted with device800 (e.g. camera 978, FIG. 9A) are displayed. In some embodiments,images are provided by a separate imager, e.g. an external ultrasoundimager. In some embodiments, real time images are displayed, forexample, real time images from the camera within the patient, externalreal time imaging (e.g. external ultrasound). In some embodiments,displayed images are previously acquired e.g. CT, MRI, nuclear imagingimages. In some embodiments, images are calculated images, e.g. ananatomic model.

Exemplary Image Processing

In some embodiments, collected images are displayed. For example, insome embodiments, images captured by an internal camera are directlydisplayed. For example, in FIG. 45, upper image 4554 a displayed bydisplay 4554 is an image provided by camera 4501.

Alternatively or additionally, in some embodiments, images are processedbefore display.

In some embodiments, images are combined and/or superimposed fordisplay. For example, in some embodiments, real time imaging (e.g. froma camera within the patient) is superimposed or displayed concurrentlywith previously acquired images or other data (e.g. CT and/or MRI and/oran anatomic model and/or device sensor data etc.).

In some embodiments, images are re-orientated before display. Referringnow to FIG. 45, for example, in some embodiments, internal camera 4501has a field of view (FOV) 4501 a and views a body part from onedirection and a user view 4564 a of this organ is from anotherdirection: In some embodiments, the captured images from the camera arere-orientated to the user view, for example lower image 4554 b displayedon display 4554 which shows an image collected by camera 4501 which hasbeen orientated to the user view of the patient 4564 a. For example, insome embodiments, a device including a camera is inserted through thevagina providing a proximal view of the device arms and uterus but thepatient is in a supine position on a surgery bed and, for example, auser view of the uterus is in the posterior direction. In someembodiments, captured images from the camera are processed (e.g. by aprocessing application) and re-orientated to the user view.

In some embodiments, a user controls (e.g. through a user interface) thedisplayed view, for example, the user rotates and/or zooms in or out onthe image. In some embodiments, a measured user view (e.g. distance andorientation of the user's head with respect to the patient and/ordevice) with respect to the patient is used to re-orientate capturedimages.

Exemplary Device Support, Optionally Device does not Require Supportfrom a User

In some embodiments, the device is stand-alone and, for example, doesnot require support of a user. In some embodiments, one or more portionof the device is at least partially supported by a support. In someembodiments, the user does not directly interact with the device. Insome embodiments, movement of the device is substantially automated.

FIG. 11A is a simplified schematic view of a system 1150 where a device1100 is held by a support 1182, according to some embodiments of theinvention.

In some embodiments, a device 1100 is coupled to a bed 1180. In someembodiments, a patient 1160 lies on bed 1180 for surgical proceduresusing device 1100. In some embodiments, one or more component of thedevice, for example one or more part of device control (e.g. motors) islocated underneath bed, e.g. in a housing 1184. In some embodiments,support 1182 connects device 1100 to housing 1184. Optionally, othercomponents, for example transformers, connectivity to other componentse.g. the display, are located in housing 1184.

In an exemplary embodiment, a main motor unit for control of movement ofthe device is located in housing 1184, where for example, in someembodiments, torque transfer element/s transfer torque from motor/swithin housing 1184 to device 1100 and/or elongated elements foreffecting flexion of device joints are coupled to motors within housing1184.

In some embodiments, control of movement of the device above the bed,using a motor unit underneath the bed is via an orientation controller,for example using a parallelogram linkage, e.g. as described inInternational Patent Application Publication No. WO2011/036626 which isherein incorporated by reference into the specification in it's'entirety.

A potential benefit of one or more component being located underneath abed (e.g. inside housing 1184), is reduced footprint of the system in anoperating room. A further potential benefit of components being locatedunderneath a bed as opposed to above and/or around the bed ispotentially improved access to a patient (e.g. in an emergencysituation).

A potential benefit of the device being coupled to a bed is the abilityto move and/or change an angle of the bed, for example, during surgery,while the device remains in the same position relative to the bed and/orpatient. Alternatively, or additionally, in some embodiments, a deviceposition with respect to the patient and/or the bed is adjustable, forexample, before treatment with the device and/or during surgery.

Optionally, in some embodiments, support 1182 moves device into positionfor surgery. In some embodiments, support 1182 moves device into adesired position for insertion into patient 1160. In some embodiments,support 1182 moves device vertically, and/or horizontally, and/orlaterally, and/or inserts device 1100 into a patient 1160 and/orwithdraws device 1100 from the patient.

In the embodiment illustrated by FIG. 11A, support arm 1182 and housing1184 are located at the foot end of 1584. A potential benefit of thislocation is ease of surgery through a patient's undercarriage, forexample, through the vagina. In FIG. 11A, patient 1160 is illustrated ina suitable position for insertion of the device into the vagina, thepatient's legs are elevated and apart (e.g. held by stirrups which arenot shown).

FIG. 11B is a simplified schematic view of a system 1150 where a device1500 is held by a support 1582, according to some embodiments of theinvention. In the embodiment illustrated by FIG. 11B, support arm 1182and housing 1184 are located at a long axis center of the bed 1180. Apotential benefit of this location is ease of abdominal and/or thoracicsurgery using the device.

In some embodiments, a housing position underneath the bed and/or aposition around the bed from where the arm meets the housing areadjustable. For example, the arm and/or housing are moved for differentsurgeries.

FIG. 12 is a simplified schematic side view of a system 1250 including adevice with two arms 1200 held by a support 1282, and coupled to anoperating surface 1280, according to some embodiments of the invention.

Optionally, in some embodiments, device support 1282 couples device 1200to operating surface 1280 (e.g. a table/bed e.g. by which a patient issupported). In some embodiments device support 1282 is flexible e.g.along the entire device support length. In some embodiments, devicesupport 1282 includes a chain of coupled segments. In some embodiments,motor/s 1284 for actuation of device 1200 are located within a supporthead.

A potential benefit of a flexible and/or adjustable device support isthe ability to position the device with relation to the operatingsurface in wide variety of positions and/or angles. Further potentialbenefits include; a small system footprint, shorter time forpreparation, for example patient preparation (e.g. anesthesia), an easydocking process. Further potential benefits include, an ability tochange the position of the patient's lower body with respect to thepatient's upper body, optionally during treatment and/or surgery withthe device, e.g. ability to adjust the Trendelburg position optionallyduring treatment and/or surgery. Further potential benefits includesmall cost and/or size of capital equipment and/or no need for adedicated operating room e.g. as device and/or system is easily moveable(e.g. small size and/or weight and/or lack of requirement of specialoperating room infrastructure).

In some embodiments, a device is inserted into a patient from adirection which is not above the patient (e.g. laterally, e.g. betweenpatient legs). In some embodiments, attachment of the device to apatient bed enables insertion directions which are not from above.

In some embodiments, a surgical system includes a port, for example,through which a device is inserted into a patient. In some embodiments,the port is coupled to the patient, for example, inserted into a naturalorifice and/or an incision.

In some embodiments, a port is coupled to a support. FIG. 13 is asimplified schematic side view of a system 1350 including a port 1312coupled to an operating surface 1380 by a support 1382, according tosome embodiments of the invention. In some embodiments, a device 1300and a port 1312 are coupled by the same support 1382.

In some embodiments, a device and a port are held by different supportelements. FIG. 14 is a simplified schematic side view of a system 1450including a port support 1482 b and a device support 1482 a, accordingto some embodiments of the invention. In some embodiments, both a device1400 and a port 1412 are coupled to an operating surface 1480.Alternatively or additionally, in some embodiments, device 1400 and/orport 1412 are held by a support coupled to one or more other object,e.g. the floor, the ceiling.

A potential benefit of supports (e.g. device and/or port supports) isreduction of unwanted movement of the device and/or port.

In some embodiments, a support is a laparoscopic positioner, for exampleincluding an attachment to a support surface rail. In some embodiments,commercially available surgical positioning arms are suitable for usewith the device of the invention, for example, surgical arms sold byFisso® of Switzerland.

FIG. 15 is a simplified schematic of a device 1500, held by a support1582, according to some embodiments of the invention.

In some embodiments, support 1582 attaches to a portion of a patientoperating surface, e.g. rail 1502. In some embodiments, position ofattachment of support 1582 on rail 1502 is adjustable, for exampleenabling linear adjustment of position of attachment of the support tothe patient operating surface.

In some embodiments, support 1582 is attached to port 1512 and a motorunit 1514 (operation of motor unit 1514 is, in some embodiments, forexample, as described regarding motor unit 4000, FIG. 40), device 1500being supported by attachment to motor unit 1514.

In some embodiments, support 1582 includes a plurality of articulationswhere angles between segments and/or segment lengths are adjustable, forexample, enabling adjustment of position and/or angle of a device 1500including mechanical limbs and/or a port 1512 and/or motor unit 1514(e.g. which actuate device 1500 limb/s).

In some embodiments, one or more motor is used to move device 1500, withrespect to one or more portion of the system (e.g. with respect to port1512 and/or motor unit 1514), for example, into and/or out of a patient.In some embodiments, motor unit 1514 includes one or more motor formovement of one or more device arm with respect to the motor unit,where, for example, one or more support segment position is changed withrespect to the motor unit. In some embodiments, movement of device 1500is controlled by a user using input object control and/or a userinterface.

Exemplary User Held Device

In some embodiments, the device is held by a user.

For example, in some embodiments, a user holds positions and/or insertsthe device while controlling the device, e.g. holding device with onearm, controlling device arm movement with the other arm, e.g. manuallyinserting the device, once the device is inserted, controlling devicearm movements with user arms.

For example, in some embodiments, a first user supports and/or insertsthe device into a patient and a second user controls movement of devicearms within the patient.

In some embodiments, a device is partially supported by a support and auser provided additional manual support and/or guiding of the device.

Exemplary Method of Use

FIG. 16 is a flowchart of a method of use of a device, according to someembodiments of the invention.

At 1686, a device including a plurality of arms is inserted through anincision in a patient. At 1688, an object controls device arm movement,for example, measured user arm movements and/or measured movement of aninput device (e.g. moved by a user) direct device arm movement withinthe patient. At 1690, the device is removed through the incision.

Exemplary Incisions and Types of Surgery

In some embodiments, the device is used in surgeries using a singleincision. In some embodiments, the device is used in laparoscopicsurgery, including, for example, SILS (Single Incision LaparoscopicSurgery). FIG. 17A is a simplified schematic of a single incision in apatient, according to some embodiments of the invention. In someembodiments, the device is inserted through a single incision, e.g. asillustrated in FIG. 17A which illustrates a single umbilical incision.

In some embodiments, different parts of the device are inserted intomore than one incision. FIG. 17B is a simplified schematic of multipleincisions in a patient, according to some embodiments of the invention.For example, in some embodiments, a first device arm is inserted througha first incision and a second device arm is inserted in a secondincision. In some embodiments, the device is inserted through a singleincision and additional tools, for example a tool for inflation of theabdominal cavity are inserted through one or more separate incision.

FIG. 17C is a simplified schematic of an incision in a patient,according to some embodiments of the invention. The incision illustratedin FIG. 17C is larger than necessary for insertion of the device intothe body and/or larger than laparoscopic surgery incision. For example,the largest extent of the incision on the skin surface is larger than 1cm or more, or 2 cm or more, or 10 cm or more, or 20 cm or more. In someembodiments, the device is used where at least a portion of the inserteddevice and/or portion of the device under a skin level is visible to auser. Optionally, e.g. when the device is at least partially visible,the system lacks an imager inserted into the body and/or images are notdisplayed to the user.

Exemplary Insertion into a Natural Orifice

In some embodiments, the device is used in NOTES (Natural OrificeTranslumenal Endoscopic Surgery). In some embodiments, a deviceincluding at least one mechanical limb (e.g. as described elsewhere inthis document) is inserted into a natural orifice, for example, thevagina, rectum, mouth. In some embodiments, once the device is insertedinto a natural orifice, the device is inserted further into the bodythrough an incision in the natural orifice. In some embodiments, oncethe device is inserted into the natural orifice, the device is insertedfurther into the body through a natural channel (e.g. esophagus, colon)and then, optionally, through an incision in the natural channel.

A potential benefit of treatments and/or operating using the device whenperforming NOTES is the ability of the device to bend within the body,potentially providing a wide range of angles of approach to a target(e.g. surgery and/or treatment of target).

In some embodiments, a device including one or more jointed mechanicalarms provides a large range of access directions and/or treatmentmovements when inserted into a narrow orifice and/or lumen e.g. largerthan less flexible laparoscopic tools.

FIG. 18 is a simplified schematic of a device including at least onemechanical limb (e.g. as described elsewhere in this document) isinserted through a natural orifice performing surgery, according to someembodiments of the invention. In some embodiments, the device isinserted into a patient vagina, and further into a patient body throughan incision e.g. in the vagina. FIG. 18 illustrates a device including aplurality of arms 1804, 1806 which has been inserted from the vaginathrough the cervix into the uterus 1892. Device hand tools 1824, 1826are operating on a fallopian 1894 tube where access is provided throughan incision 1862 in the uterus.

In an exemplary embodiment, a device including at least one mechanicallimb (e.g. as described elsewhere in this document) is inserted throughthe vagina and an incision in the posterior fornix into the Pouch ofDouglas to, for example, operate on the uterus (e.g. performhysterectomy). In an alternative embodiment, a device including at leastone mechanical limb (e.g. as described elsewhere in this document) isinserted through the nostril and/or mouth to a sinus to operate on thesinus. In an alternative embodiment, a device including at least onemechanical limb (e.g. as described elsewhere in this document) isinserted through the esophagus to operate on the stomach.

Exemplary Mechanical Arm Controller Located Remotely

In some embodiments, a controller including elements (e.g. motors) forrotation of device arm segments and/or bending of device arm segmentsare located remotely, for example, in some embodiments, control elements(e.g. motors) are located in a device torso and/or in a device support(e.g. as described previously).

Exemplary Remote Control of Flexion and Extension

In some embodiments, flexion and/or extension of segments about jointsand/or bending (e.g. flexion and/or extension of effective segments withrespect to each other) is controlled remotely by means of elongatedelements (e.g. wire, ribbon, tape, cable) coupled to each segment; bychanging tension of one or more of the elongated elements (e.g. pulling,releasing), the segment coupled to the element flexes or extends. Insome embodiments, a segment is bent in one direction by pulling on afirst elongated element, for example, coupled to a first side of thesegment) and straightened by pulling on a second elongated element, forexample, coupled to a second side of the segment (e.g. opposing thefirst side of the segment).

In some embodiments, one or more elongated element for control ofbending of segment/s and/or effective segment/s is coupled to the deviceinside one or more hollow portion of the device. For example, asdescribed regarding elongated element 3480 FIG. 34B and/or elongatedelements 3580 and 3581 FIG. 35B where, for example, the elongatedelements are coupled to an inner surface of one or more hollow deviceportion, for example, by guiding elements, e.g. 3486 a 3486 b 3486 cFIG. 34B, 3586 a 3586 b FIG. 35B.

In some embodiments, one or more elongated element is coupled to anouter surface of one or more device portion (e.g. a hollow deviceportion). For example, referring to FIG. 31C, in some embodiments,elongated elements (not illustrated) are coupled to outer surfaces ofportion/s of a device arm by fins 3181, 3183. In some embodiments, asurgical device limb is covered (e.g. in a sheath) for example,potentially protecting externally coupled elongated element/s.

In an exemplary embodiment, one or more elongated element is a ribbonshape, for example, including a flattened cross sectional shape (e.g.elongated element cross section is perpendicular to an elongated elementlong axis), where, for example, a largest extent of the cross section is1.25 times, or 1.5 times, or 2 times, or 3 times, or 4 times, or 10times a smallest extent of the cross section. A potential benefit of aribbon-shaped elongated element, for example, in comparison to a wireelongated element is increased strength for a given smallest crosssectional extent. In some embodiments, a ribbon shaped elongated elementis advantageous in a nested structure, where multiple elements arelocated in a limited cross-sectional space.

In some embodiments, flexion and/or extension of one or more segment isby pulling an elastic elongated component (e.g. made of nitinol, NiTi),where, upon release of the elongated component, the elongated componentelastically returns the segment, e.g. as described in InternationalPatent Application Publication No. WO2011/036626.

Exemplary Remote Control of Rotation

In some embodiments, rotation of segments is controlled by rotation ofan extension of the segment coupled to the segment (e.g. by aconnector), which extension extends to a location, for example, at adistance from the segment (e.g. extending outside the device). In someembodiments, rotation of a segment is by rotation of a bent segmentextension.

In some embodiments, segment extensions are nested (disposed) inside oneor more proximal segment, for example, a hand extension is nested insideradius and/or humerus and/or torso, a radius extension is nested insidea humerus and/or torso.

FIG. 19 is a simplified schematic of an arm 2004 with nested segmentextensions, according to some embodiments of the invention. In someembodiments, a hand 2024 coupled to a hand extension 2024E (shaded grey)is rotatable by rotation of hand extension 2024E, as illustrated by thewhite arrows on FIG. 19. In some embodiments, hand extension is nestedinside a humerus 2012, and a radius extension 2016E. In someembodiments, radius extension 2016E is nested inside humerus 2012.

In some embodiments, a segment extension includes a torque transferportion, such that a segment is rotatable using a segment extension whenthe segment extension is bent. FIG. 20 is a simplified schematic of anarm 2004, including a segment extension 2024E with a bendable torquetransfer portion, according to some embodiments of the invention.

Exemplary Torque Transfer Portion

In some embodiments, a bendable torque transfer portion includes aplurality of coupled torque transfer elements.

FIG. 21 is a simplified schematic of a torque transfer element accordingto some embodiments of the invention. In some embodiments, the torquetransfer portion includes a stack of elements coupled by torque transferportion connectors.

In some embodiments, torque transfer elements are shaped and stackedsuch that rotation of a single torque transfer element creates a torque(e.g. transferred by connector/s between elements) in the same directionon adjacent torque transfer elements, causing the adjacent torquetransfer elements to rotate.

In an exemplary embodiment, a torque transfer element is coupled to anupper torque transfer element with two connectors 2196 a, 2196 b, and alower element with two connectors 2196 c, 2196 d. In some embodiments,each element includes four beams, two upper beams 2198 a, 2198 b,connected to an upper adjacent element (not illustrated) and two lowerbeams 2198 c, 2198 d connected to a lower adjacent element (notillustrated). In some embodiments, connectors between elements transfertorque between elements. In some embodiments, one or more beam is rigidalong a beam long axis, for example, resisting collapse of the beamand/or twisting of the torque transfer portion.

In some embodiments, a torque transfer portion with two or moreelements, e.g. as illustrated in, FIG. 21 has open spaces at 90°intervals around the torque transfer portion, meaning that the torquetransfer portion is bendable and/or deflectable from a straight positionin any direction perpendicular to a torque transfer portion long axis bycompression and expansion of open spaces.

In some embodiments, links include more than four beams and/or more thanfour connectors, and, for example, torque transfer portion has openspaces at less than 90° around the torque transfer portion.

In some embodiments, a maximum bending and/or deflection of the torquetransfer portion corresponds to where open spaces on the inner bend areclosed. In some embodiments, a minimum bending radius of a torquetransfer portion is 15 mm, or 10 mm, or 8 mm, or 6 mm, or 4 mm. In anexemplary embodiment, a minimum bending radius of a torque transferportion is 10 mm. In an alternative exemplary embodiment, a minimumbending radius of a torque transfer portion is 6 mm. FIG. 22 is a torquetransfer portion spreading pattern, according to some embodiments, ofthe invention. Visible in FIG. 22 are connections 2296 between elementsand open spaces 2299 between the beams.

FIG. 23 is a simplified schematic side view of a straight torquetransfer portion with a first and a second element 2397 a, 2397 b,according to some embodiments of the invention. FIG. 24 is a simplifiedschematic side view of a bent torque transfer portion with two elements,according to some embodiments of the invention. In FIG. 23, midpoints2402 illustrate exemplary elastic bending of the beams.

In some embodiments, as illustrated by FIG. 24, when the torque transferportion bends, open spaces between elements on the outer side of thebend expand 2499E and/or open spaces on the inner side of the bendcontract 2499C.

In some embodiments, during bending, a torque transfer portion length(e.g. as illustrated by a dotted line in FIG. 23 and FIG. 24) does notchange in length (maintains an original length).

In some embodiments, elements are constructed by laser cutting a hollowtube. In some embodiments, a torque transfer portion is able to transfer100 g over 100 mm, 0.1 Nm. In some embodiments, a torque transferportion is able to transfer 0.01-1 Nm or 0.01-0.5 Nm or lower or higheror intermediate ranges or torques. In some embodiments, torque transferability of the torque transfer portion is associated with strength ofconnections e.g. connections 2292 FIG. 22 and/or a resistance tocollapse of the torque transfer portions.

FIG. 25 is a simplified schematic side view of a straight torquetransfer portion with plurality elements, according to some embodimentsof the invention. FIG. 26 is a simplified schematic side view of a benttorque transfer portion with a plurality of elements, according to someembodiments of the invention.

Exemplary Joints

In some embodiments, joints are formed by one or more link. In someembodiments, joints are formed by a stack of a plurality of links. FIG.27 is a simplified schematic of a straight joint 2700 including twolinks 2702, according to some embodiments of the invention.

FIG. 28 is a simplified schematic of a joint 2800 including two links,where the links are rotated about a joint long axis, according to someembodiments of the invention.

In some embodiments, links include one or more air gap 2799, 2899 forexample, allowing deflection in one direction (e.g. so that, flexionand/or extension is uni-directional). In some embodiments air gaps 2799,2899 are located on the same side of sequential links. In someembodiments, air gaps 2799, 2899, do not extend around the links,restricting a direction of bending of the joint.

In some embodiments, one or more link includes a wedge 2760, 2860,which, for example, prevents the links from disassembling, e.g. when thejoint bends. In some embodiments, links include connectors 2762, 2862(e.g. link pins), which couple a link to adjacent links.

In an exemplary embodiment, each link is rotatable by up to 16° from thejoint long axis. In some embodiments, for 90° of flexion 6 links areused, in some embodiments, for 180° of flexion 12 links are used.

FIG. 29 is a side view of a joint including a plurality of links, wherethe links are rotated about a joint long axis, according to someembodiments of the invention. In some embodiments, guiding element,(e.g. fin or ring as described in more detail below), is coupled to alink. In some embodiments, guiding elements are coupled to more than onelink. FIG. 30 is a simplified schematic side view of a joint including aplurality of links, where a plurality of links include guiding elements3086, according to some embodiments of the invention. In the embodimentillustrated by FIG. 30 guiding elements are rings.

In some embodiments, guiding elements are coupled to links by a portionof the ring that protrudes through a hole or slot. Referring back toFIG. 29, slots 2994 are visible in some links.

In an exemplary embodiment, guiding fins and/or rings are fitted tojoints by inserting the rings inside the joints.

Exemplary Arm Embodiments

FIG. 31A is a simplified schematic cross sectional view of an arm 3104with nested segment extensions, according to some embodiments of theinvention. FIG. 31B is a simplified schematic of a side view of aportion of an arm, according to some embodiments of the invention.Dashed lines illustrate the portion of the arm illustrated in FIG. 31Aillustrated by FIG. 31B.

In some embodiments, arm 3104 includes a hand tool 3124 coupled to aradius 3116 at a wrist joint 3128.

In some embodiments, radius 3116 is coupled to a radius extensionincluding two torque transfer portions; an elbow torque transfer portion3116ETT disposed inside an elbow joint 3120 and a shoulder torquetransfer portion 3116STT disposed inside a shoulder joint 3108. In someembodiments, radius 3116 is coupled to a humerus 3112 by a connector3116C. In some embodiments, portion 3116C connects radius 3116 tohumerus 3112 whilst allowing free rotation of humerus 3122. In someembodiments, at region A of FIG. 31A, protrusion/s on radius portion3116 fit into indentation/s on portion 3116C. In an exemplaryembodiment, a ring shaped protrusion on radius portion 3116 (e.g. a ringof material connected (e.g. welded) to radius portion 3116) fits into anindentation on portion 3116C. Similarly, in some embodiments, portions3112C and 3112 are connected by matching protrusion/s and indentation/s(e.g. a ring protrusion on portion 3112 fitting into a matchingindention in portion 3112C).

In some embodiments, a “connecting section” includes a connector and ajoint, for example shoulder joint 3108 and connector 3112C, for exampleelbow joint 3120 and connector 3116C.

FIG. 31C is a simplified schematic cross sectional view of a portion ofan arm, according to some embodiments of the invention. In someembodiments, for example, at A portion includes a ring protrusion whichfits into an indentation on portion 3116C.

In some embodiments, portion 3116C provides anchoring to one or moreelongated element: for example, where elongated element/s areconnected/coupled to portion 3116Canc.

In some embodiments, one or more connector couples portions whilstallowing one portion to rotate within the connector about the portion'slong axis. For example connecting portion 3116C allows radius 3116 torotate within connecting portion 3116C about a radius long axis.

In some embodiments, humerus 3112 is coupled to a humerus extensionincluding one torque transfer portion, a shoulder torque transferportion 3112STT disposed inside shoulder joint 3108. In someembodiments, the humerus is coupled to a torso 3102 by a connector3112C.

In some embodiments, a mechanical arm includes a first and a sectionflexible portion (e.g. elbow joint and shoulder joint) which are coupledtogether with a short connecting segment (e.g. a humerus sectioncoupling a shoulder and elbow joint is short). In some embodiments,coupling between the flexible portions is a point connection (e.g. ashoulder and elbow joint are directly connected).

In some embodiments, a rigid anchoring portion (e.g. portion 3116C)connects two flexible portions, where the anchoring portion providesanchoring of elongated elements which control flexion and extension ofthe joint which is, for example, proximal to the elongated portion. Insome embodiments, anchoring is provided by a portion of one of thejoints, e.g. a distal portion of the proximal joint.

In some embodiments, one or more rigid segment is absent: FIG. 32 is asimplified schematic cross sectional view of an arm 3204 with nestedsegment extensions, according to some embodiments of the invention. Insome embodiments, elbow joint 3220 and shoulder joint 3208 are directlycoupled (e.g. arm 3204 lacks a humerus portion).

FIG. 33A is a simplified schematic cross sectional view of an exemplaryarm 3204 with nested segment extensions, according to some embodimentsof the invention.

FIG. 33B is a simplified schematic of a hand tool 3324 coupled to aradius, coupled to a radius segment extension 3316E, according to someembodiments of the invention. In some embodiments, radius segmentextension 3316E includes an elbow torque transfer portion 3316ETT and ashoulder torque transfer portion 3316STT.

As was described previously, in some embodiments, elongated elements areused to control flexion and extension of the arm segments at arm joints.In some embodiments, elongated elements pass through an axial void in asegment and/or joint and/or segment extension and/or torque transferportion.

FIG. 33C is a simplified schematic cross sectional view of a portion ofa radius extension, according to some embodiments of the invention. Insome embodiments, one or more elongated element 3370 is coupled totorque transfer portion links 3324STT, 3324ETT, by guiding elements. Insome embodiments, guiding elements are fins 3386. Alternatively oradditionally, in some embodiments, guiding elements are rings.

In some embodiments, during rotation of a segment extension (andsegment), elongated elements remain in position within the element, forexample rotate with the element, e.g. as they are coupled in position byguiding elements (e.g. fins 3386).

In some embodiments, an electricity supply cable 3371 passes through theradius segment extension, for example, to supply electricity to a handtool (e.g. for electro surgery).

FIG. 34A is a simplified schematic side view of a device arm portionincluding a humerus coupled to a humerus extension 3412E, according tosome embodiments of the invention. FIG. 34B is a simplified schematiccross sectional view of a humerus 3412 coupled to a humerus extension3412E, according to some embodiments of the invention.

In some embodiments, elbow joint 3420 is coupled to two or moreelongated elements, a first elongated element 3480 is pulled to bend(flex or extend) radius 3416 in one direction, and a second elongatedelement (not illustrated) is pulled to bend the radius in the oppositedirection. In some embodiments, elbow joint 3420 is coupled to more thantwo elongated elements, potentially increasing a maximum load (e.g.radius, tissue held by a hand tool) that the elements move.

In an exemplary embodiment, elongated element 3480 is coupled to elbowjoint 3420 links by guiding elements (e.g. fins 3486 a) and to shouldertorque transfer portion links by guiding elements (e.g. fins 3486 c). Insome embodiments, fins 3486 each hold the elongated element, in a gap3488, whilst allowing elongated element 3480 to slide (e.g. be pulled,be released) within gap 3488. In some embodiments, one or more guidingelement is a ring. In some embodiments fins and/or rings hold anelongated element at an inner edge of a hollow region (e.g. of a segmentand/or joint, and/or torque transfer portion).

Similarly, in some embodiments, a second elongated element (notillustrated) is coupled to a different part of the inner edge of thehollow region. For example, the second elongated element is coupled to adiametrically opposing side of elbow joint 3420 by second elongatedelement fins 3486 b coupled to links on the opposite side of elbow joint3420. In some embodiments, first elongated element fins 3486 a andsecond elongated element fins 3486 b are coupled to different links, forexample, alternating links. In an exemplary embodiment, the firstelongated element fins and the second elongated element fins are coupledto alternative links, with two links without fins between every firstelongated element fin second elongated element fin pair.

In some embodiments, one or more elongated element 3420 is fixed to aportion 3416C. For example, in some embodiments, a distal end ofelongated element 3420 is fixed to portion 3416C. Alternatively, in someembodiments, elongate element is only slidably coupled, for example,looping through a gap in portion 3416C.

FIG. 35A is a simplified schematic side view of a shoulder joint 3508coupled to a torso 3502, according to some embodiments of the invention.FIG. 35B is a simplified schematic cross sectional view of a shoulderjoint 3508 coupled to a torso 3502, according to some embodiments of theinvention. In some embodiments, a first elongated element (e.g. cable,ribbon, wire, tape) 3580 is coupled to links in shoulder joint by fins3586 a. In some embodiments, a second 3581 elongated element cable iscoupled to links in shoulder joint by fins 3586 b. In some embodiments,one or more additional elongated element is coupled to a first elongatedelement, potentially providing increased strength. In some embodiments,cables and fins have functionality as described above, regarding theradius and radius extension.

Exemplary Motor Actuation

In some embodiments, a device including one or more mechanical limb(e.g. as described elsewhere in this document) is actuated by a motorunit coupled to a proximal end of the arm/s.

In an exemplary embodiment, bending (flexion and extension) and rotationof a single joint is controlled by movement of two gears. FIG. 39 is asimplified schematic side view of an actuation mechanism 3901 forcontrol of a mechanical limb joint, according to some embodiments of theinvention.

In some embodiments, a rotation gear 3902 is coupled to a central shaft3904, where central shaft 3904 is coupled to an extension (e.g. 3316E,FIG. 33A). In some embodiments, a distal portion of central shaft 3904(in direction D of rotation gear 3902) is coupled to the extension. Insome embodiments, rotation of rotation gear 3902 causes rotation ofcentral shaft 3904 which in turn rotates the extension coupled to thecentral shaft.

In some embodiments, a bending gear 3906 is coupled to a portionincluding screw threading 3908. Rotation of the bending gear 3906 causesrotation of screw threading 3908. In some embodiments, a first nut 3910and a second nut 3912 are coupled to screw threading 3908 such thatrotation of the screw threading generates linear movement of nutsparallel to a long axis 3914 of central shaft 3904 where first nut 3910and second nut 3912 move in different directions. In some embodiments,first nut 3910 and second nut 3912 are connected to elongated elements3910 ee and 3912 ee respectively, where linear movement of the nutspulls one elongated element whilst releasing and/or pushing on theother, generating flexion/extension of the joint. In some embodiments,rotation of the joint is effected by rotation of both rotation gear 3902and bending gear 3904. In some embodiments, bending of the joint iseffected by rotation of the bending gear only. In some embodiments,concurrent bending and rotation of the joint is effected by rotation ofthe rotation gear and bending gear by different extents and/or indifferent directions. For example, in some embodiments, concurrentbending and rotation of the joint is effected by holding the bendinggear stationary whilst rotating the rotation gear.

In some embodiments, a cover 3916 covers the central shaft, screwthreading and nuts, for example, potentially preventing debris or othermaterial from entering the mechanism.

In some embodiments, each mechanical device joint is coupled to anactuation mechanism as described above (e.g. by an extension coupled tothe joint). For example, in some embodiments, each extension portion(e.g. as describe above) is coupled to a central shaft, and elongatedportions for control of flexion and extension (e.g. as described above)are coupled to nuts of the actuation mechanism. In some embodiments,actuation mechanisms for a single mechanical limb are arranged linearly,with central shafts disposed in a nested configuration, the innercentral shafts protruding for control by the gears.

FIG. 40 is a simplified schematic side view of a motor unit 4000 foractuation of a device including mechanical arms, according to someembodiments of the invention. In some embodiments, a device including afirst mechanical arm 4002 and a second mechanical arm 4006 arecontrolled by motor unit 4000.

In some embodiments, a first actuation mechanism 4001 a, including firstrotation gear 4002 a and first bending gear 4006 a, drivesflexion/extension and rotation of a shoulder joint. Referring now toFIGS. 35A-35B, for example, in some embodiments, first actuationmechanism 4001 a rotates the shoulder joint by rotating portion 3502 andeffects flexion and extension of joint 3508 by movement of elongatedelements (e.g. 3581 in FIG. 35B) attached to portion 3512C.

In some embodiments, a second actuation mechanism 4001 b, includingsecond rotation gear 4002 b and second bending gear 4006 b, drivesflexion/extension and rotation of an elbow joint. In some embodiments,one or more driving gear coupled to a motor is disposed underneath motorunit 4000. For example, in some embodiments, a gear which drives secondbending gear 4006 b, which gear is coupled to a motor is disposed on anunderside of motor unit 4000. For example, gear 4099 drives a secondactuation mechanism corresponding to second mechanical arm 4006.Referring now to FIGS. 34A-34B, for example, in some embodiments, secondactuation mechanism 4001 b rotates the elbow joint by rotating portion3412E and effects flexion and extension of joint 3508 by movement ofelongated elements (e.g. 3480 in FIG. 34B) attached to portion 3416C.

In some embodiments, a third actuation mechanism 4001 c, including thirdrotation gear 4002 c and third bending gear 4006 c, actuates an endeffecter (e.g. opens and closes a gripper) and drives rotation of awrist joint. Referring to FIG. 1C, in some embodiments, third actuationmechanism 4001 b rotates and actuates end effecter 124; For example, insome embodiments, rotation of third rotation gear 4006 c opens andcloses an end effecter (e.g. end effecter 124, FIG. 1A). For example, insome embodiments, a gripper includes a rotation/screwing open-closemechanism e.g. as described regarding FIG. 36B, and rotation of thirdrotation gear 4006 c opens and closes an end effecter. In someembodiments, rotation of rotation gear 4006 c rotates nut 3602.

In embodiments where a device arm also includes a wrist joint (e.g. asillustrated by FIGS. 33B-33C) which can bend, the motor unit includes anadditional mechanism for actuating flexion/extension of the wrist joint.

In some embodiments, similarly, second mechanical limb 4006 is actuatedby three actuation mechanisms, including, for example, 6 motors. In anexemplary embodiment, a device for insertion into the body includes twomechanical limbs, actuated by 12 motors.

In some embodiments, one or more additional motor (e.g. a 13^(th) motor)moves the device arms towards and/or away from the motor unit. Forexample, in some embodiments, a position of attachment of the motor unit(e.g. to a support and/or to a patient support surface) is changed e.g.by a motor.

For example, referring to FIG. 15, in some embodiments, a position ofattachment of support 1582 with respect to rail 1502 is changed (e.g. bya motor located on support 1582). For example, in some embodiments, aposition of attachment of motor unit 1514 with respect to support 1482is changed (e.g. by a motor located on support 1582).

For example, moving the device into and/or out of a patient body e.g.when the motor unit is supported in a fixed configuration and/or toautomate movement of the device into the patient. In some embodiments, amotor located within motor unit 4000 moves the device arms into and/orout of a patient.

In some embodiments, for example, so that rotation of a joint alsocauses rotation of joints distal of the rotated joint, more than oneactuation mechanism is driven in rotation of the joint. For example, insome embodiments, for rotation of the shoulder joint, gears 4002 a, 4006a, 4002 b, 4006 b, 4002 b, 4006 b are rotated in the same direction. Forexample, in some embodiments, for rotation of the elbow joint, gears4002 b, 4006 b, 4002 b, 4006 b are rotated in the same direction. Forexample, in some embodiments, for rotation of the end effecter, gears4002 b, 4006 b are rotated in the same direction. In some embodiments,concurrent rotation of nested portions with outer portions preventsstress on and/or tangling of internal elongated elements (e.g. elongatedelement/s which are used to effect flexion/extension, e.g. elongatedelement/s providing power supply).

In some embodiments, one or more actuation mechanism is used toflex/extend a joint. For example, in some embodiments, to bend ashoulder joint, elongated elements for bending of both the shoulderjoint and elbow joint are moved. In some embodiments, if elongatedelements for the elbow are not moved and/or released, tension in theelongated elements associated with the elbow joint resist movement ofthe shoulder joint. For example, bending of the shoulder joint iseffected by rotation of gears in first actuation mechanism 4001 a andsecond actuation mechanism 4001 b are rotated.

In some embodiments, the motor unit includes one or more positionsensor, and/or is controlled by a processor including a memory whichstores commands. In some embodiments, data from position sensor/s and/orfrom control memory is used to infer a position of device portion/s.

In some embodiments, a motor unit is small, for example, with 100-600mm, or 200-400 mm, or about 300 mm long axis length and about 20-100 mm,or 30-80 mm, or 60 mm maximum extent perpendicular to the motor unitlong axis.

In some embodiments, motor unit 4002 includes structure (e.g. includingelectrical contact/s), for example, for delivery of monopolar and/orbipolar energy to the device (e.g. to a device end effecter). FIG. 41 isa simplified side view of a portion of a motor unit including elementsfor electrical supply to an end effecter, according to some embodimentsof the invention.

In some embodiments, portion 4130 is coupled to an end effecter suchthat, when 4130 is rotated, it rotates an end effecter, for example,portion 4120 is coupled to portion 3316C of FIG. 33B. In someembodiments, gear 4132 actuates the end effecter, for example, rotationof gear 4132 opening and/or closing jaws of a grasper end effecter. Insome embodiments, contacts 4122 and 4124 provide electricity supply toring portions 4126 and 4128 respectively. In some embodiments, one ofcontacts 4122, 4124 provides positive voltage and the other negative,providing bipolar power supply. In some embodiments, each of ringportions 4126 and 4128 are electrically connected (e.g. through wiresrunning through 4130) to an end effecter, where one of the ring portionsis coupled to one side of a grasper and the other to the other side of agrasper. For example, referring to FIG. 36B, in some embodiments, 3624 aand 3624 b are electrically coupled to ring portions 4126 and 4128.

In some embodiments, electrical power supply is supplied through wiresto the motor unit, for example, referring to FIG. 40, in someembodiments, contacts 4020 are connected to an electrical power supply.

In some embodiments, a motor unit drives more than two mechanical limbsand/or drives additional device elements. For example, in someembodiments, a motor unit drives two device limbs and a camera. FIG. 10Bis a simplified schematic side view of part of a motor unit 1050 foractuation of a device including more than two arms, according to someembodiments of the invention. In some embodiments, motor unit 1050includes actuation device/s for joint/s of a third limb. For example, inthe embodiment illustrated by FIG. 10A, a motor unit has a singleactuation unit for actuation of joint 1010. In some embodiments, motorunit includes one or more curved portion 1052, for example, throughwhich central shaft/s pass. In some embodiments, central shaft/s passingthrough curved portion 1052 include torque transfer portion/s (e.g. asdescribed elsewhere in this document).

Exemplary Hand Tools

In some embodiments, one or more device limb most distal segment (e.g.hand segment) includes a hand tool.

In some embodiments, tools directly treat the patient (e.g. cutting,moving tissue), e.g. other portion of the device limbs locating thetool/s in the correct position and/or moving the tool/s.

In some embodiments, additionally and/or alternatively, a hand toolcollects information. For example, in some embodiments, a hand tool is acamera. For example, in some embodiments, a hand tool includes one ormore sensor.

In an exemplary embodiment, a hand tool is attached by a wrist joint tothe distal end of the radius segment. In some embodiments, a device limbincludes one or more tool coupled to the limb at a point other than thedistal end of the limb e.g. a joint. For example, in some embodiments, alimb includes a tool coupled to the elbow joint or near to the elbowjoint on the radius and/or humerus, the tool e.g. for holding tissueaway from the hand tools.

In some embodiments, a limb does not include a hand tool and, forexample, the radius (e.g. distal end) pushes or moves tissue. In someembodiments, a tool e.g. scissors, grasper, is used as a bluntinstrument e.g. for pushing tissue.

Exemplary Scissors

In some embodiments, a device arm includes a scissors hand tool.Referring back to FIG. 3, scissor hand tool 324 includes a first portion325 a coupled to a second portion 325 b. In some embodiments, scissorshand tool 324 cut by a flat surface of first portion 325 a sliding intoclose proximity and/or contact with a flat surface of second portion 325b. Optionally one or more portions 325 a, 325 b include a sharpenededge. In some embodiments, scissor hand tool 324 cuts tissue.Alternatively, or additionally, in some embodiments scissor hand tool324 is used to push and/or hold patient tissue, e.g. when scissors areclosed. In some embodiments, one or more part of scissor hand tool 324is charged for electrosurgery, as described in more detail below.

Exemplary Grasper

In some embodiments, a device arm includes a grasper hand tool. In someembodiments, a grasper includes two or more opposing portions and thegrasper is closed by bringing two or more opposing portions together,for example, to grasp an object (e.g. patient tissue). In someembodiments, opposing portions move apart to open the grasper. FIG. 36Ais a simplified schematic of a closed grasper hand tool 3624, accordingto some embodiments of the invention. FIG. 36B is a simplified schematicof an open grasper hand tool 3624, according to some embodiments of theinvention.

In some embodiments, a first grasper side 3624 a is pivotally coupled toa second grasper side 3624 b. In some embodiments, in moving from anopen grasper configuration to a closed grasper configuration, opposingsurfaces of first grasper side and second grasper side move towards eachother. In some embodiments, as illustrated in FIG. 36A, if there is noobject in between grasper sides 3624 a, 3624 b, the closing the grasperbrings the opposing surfaces 3624 c of the sides into in contact.Optionally, in some embodiments, one or more side of a grasper includesprotrusions, for example, one or more serrated edge and/or one or moreprotruding tooth. Potentially protrusions provide improved grip (e.g.increased gripping force) on tissue that the gripper is holding.

In some embodiments, gripper opposing surfaces are smooth and/or flat(e.g. as illustrated in FIG. 36A and FIG. 36B). In some embodiments,gripper opposing surfaces are serrated and/or interlocking and/orinclude teeth, potentially increasing pressure and/or grip, e.g. as isknown in the art of surgical grippers.

In some embodiments, user tissue is held in between opposing surfaces3624 c. In some embodiments, grasper hand tool holds tissue between theopposing surfaces 3624 c, a potential benefit being the ability to pulland/or tear patient tissue.

In some embodiments, a turning and/or screwing mechanism opens andcloses the grasper sides: In some embodiments, a nut 3602 is coupled toa first beam 3604 and a second beam 3606. First beam 3604 is coupled tograsper first side 3624 a and second beam 3606 is coupled to graspersecond side 3624 b. In some embodiments, turning nut 3602, for example,in one direction (e.g. clockwise) pushes the nut towards the graspersides, increasing an angle between first and second beams and openingthe grasper sides, as is illustrated in the transition between FIG. 36Aand FIG. 36B. In some embodiments, nut 3602 is turned by turning anelongated element coupled to the nut, where the elongated elementoptionally extends out of the hand tool and/or device arm. In anexemplary embodiment, the elongated element is a single nitinol element(e.g. cable, tape, wire). Other methods of actuating (opening andclosing) pincer sides using torque are envisioned and included in thisapplication. A potential benefit of using torque and/or a self lockingmechanism such as a nut and/or screw is that movement of the arminteracting with the elongated elements does not loosen the grip of thegrasper.

Alternatively or additionally, in some embodiments, opening and closingof a grasper hand tool is controlled by pulling and releasing of one ormore elongated element, as is known in the art of grasper control. FIG.37 is a simplified schematic of a closed grasper hand tool 3724,according to some embodiments of the invention.

In some embodiments, a hand tool is coupled (e.g. by a wrist joint 3628)to a connecting portion 3624Cou which couples the hand tool to theradius. In some embodiments, the wrist joint is a pivot. Alternatively,in some embodiments a device arm does not include a bendable wristjoint, for example, hand tool 3624 is directly coupled to a radiussegment.

Exemplary Grasper with Humanoid Structure

In some embodiments, a device arm includes a grasper with a humanoidstructure (a gripper hand tool). In some embodiments, one or moreopposing portion of a grasper hand tool is articulated. In someembodiments, one or more opposing portion includes the same number ofsegments and connecting joints as a human finger. FIG. 38 is asimplified schematic of a gripper hand tool 3824, according to someembodiments of the invention. Potential benefits of a hand tool withhumanoid structure include is intuitive movement of the tool, theability to perform surgical movements (e.g. suturing) in the same way asmanual surgery.

Other Exemplary Hand Tools

In some embodiments, a hand tool is used to hold and/or push user tissuee.g. to hold tissue away for cutting, to provide tension to tissue to becut. Optionally, a hand tool for holding tissue includes an expandingportion the surface of which can be expanded by one or more portionunfolding and/or inflating and/or sliding past other portions (e.g.fan-like construction).

In some embodiments, one or more hand tool is, for example, a drill, ascrewdriver, a needle, a scalpel, a suction device, a harmonic scalpel,other devices (e.g. surgical devices) as known in the art of endoscopicprocedures.

Exemplary Electrosurgery

Optionally, in some embodiments, one or more device hand tool includesone or more charged portion for electrosurgery. In some embodiments, adevice hand tool includes monopolarly charged part for monopolarelectrosurgery. In some embodiments, one part of a hand tool isnegatively charged and another part of the hand tool is positivelycharged, for bipolar electro surgery.

In an exemplary embodiment, referring to FIG. 36A and FIG. 36B, firstgrasper side 3624 a is oppositely charged to second grasper side 3624 b(e.g. first grasper side 3624 a is positively charged, second grasperside 3624 b is negatively charged or vice versa), for bipolarelectrosurgery.

In an exemplary embodiment, referring to FIG. 3, first portion 325 a isoppositely charged to second portion 325 b (e.g. first portion 325 a ispositively charged, second portion 325 b is negatively charged or viceversa), for bipolar electrosurgery.

In some embodiments, for example, a user controlling movement of adevice with user arm movements activates charge for electrosurgery usingan additional user interface (e.g. a foot pedal).

Exemplary Disposability, Replaceablity, Sterility

In some embodiments, one or more portion of the device includingmechanical arms (e.g. as described herein) is sterile and/orsterilizable (e.g. device limbs are sterile). In some embodiments, oneor more part of the device is replaceable, for example, in someembodiments, one or more device limb is replaced and/or one or more toolis replaced, e.g. between treatments.

In some embodiments, an end effecter is screw attached to the mechanicalarm, and, for example, is unscrewed to remove it from the arm.

In some embodiments, one or more mechanical arm is friction coupled tothe motor unit, for example, potentially enabling removal and/orexchange of the mechanical arms.

In some embodiments, mechanical arms include a sterile sheath and/or asterile sheath is placed over a mechanical arm e.g. before treatmentwith the device commences.

Exemplary Surgical Device Control Systems

In some embodiments, a surgical device is controlled (e.g. movement ofthe surgical system) using an input device. Alternatively oradditionally, in some embodiments, a surgical system is controlled bymeasured user body movement.

FIG. 42 is a simplified schematic block diagram of a control system,4250 according to some embodiments of the invention.

In some embodiments, system 4250 includes an input device 4200 ip, whereinput device 4200 ip includes one or more sensor 4210. In someembodiments, one or more sensor 4210 produces an output based on aposition of the input device (e.g. sensors are described in more detailelsewhere in this document).

Optionally, in some embodiments, input device 4200 ip includes one ormore user interface 4212, for example, one or more button and/or a touchscreen (e.g. mounted to an input device arm).

Alternatively or additionally, in some embodiments, user interface/s aremounted to another portion of an input device, e.g. on a surgical devicesupport and/or on another location, e.g. a patient bed.

Optionally, in some embodiments, input device 4200 ip includes aninternal processor and/or memory (not illustrated), for example, forprocessing and/or storing signals produced by sensor/s 4210 and/or userinterfaces/s.

Alternatively or additionally to input device 4200 ip, in someembodiments, system 4250 includes a user motion detection apparatus4256. In some embodiments, apparatus 4256 includes one or more motiondetection sensor 4758. In an exemplary embodiment, motion detectionsensor/s 4758 are one or more camera. In some embodiments, one or moremotion detection sensor 4758 includes an internal processor, fordetection of user body portion position and/or movement from collectedimages, and the internal processors send detected body portion positionsto processor 4716. In some embodiments, sensor/s 4758 send raw imagedata to processor 4216.

In some embodiments, system 4250 includes a processor 4216 whichreceives signals from input device 4200 ip (and/or from user motiondetection apparatus 4256) and, based on received signals generatescontrol signal/s which control one or more surgical device motor 4214.

In some embodiments, (e.g. as described in the section below “ExemplaryFiltering”) signals received by the processor from the input device arefiltered, for example, in generation of the control signals.

Optionally, in some embodiments, processor 4216 communicates with adisplay 4254. For example, in an exemplary embodiment, a displaydisplays a graphical representation of the input device and/or surgicaldevice, for example, based on signals received from input device 4200 ipand/or surgical device motors 4214.

Exemplary Method of Control

In some embodiments, movement and orientation of the device hands iscontrolled by movement of the user hands and/or movement of an inputdevice and movement of other portions of the device, is controlled byrobotics, for example, controlled by inverse kinematics, as known in theart, where inverse kinematics is concerned with calculating joint anglesof body segments given motion of some body segments in 3D space.

In some embodiments, movement and/or position of one or more joint ofthe device is controlled using robotics e.g. inverse kinematicsoptionally with movement constraints.

In some embodiments, movement of one or more joint (and/or segment) iscontrolled by measured mapped movement of the corresponding user jointand/or measured movement of a corresponding input device joint, whereone or more other joint is controlled automatically, e.g. by robotics. Apotential benefit of a user controlling one or more joint is that theuser controls a path of the device, for example, avoiding obstacles(e.g. avoiding damage to an obstacle e.g. organ).

In some embodiments, movement of a device arm end effecter (e.g. handtool) is controlled by measured mapped movement of a corresponding userbody portion and/or measured mapped movement of a corresponding inputdevice portion (e.g. the user wrist joint and/or hand position and/orradius distal end) and movement of one or more other joint is controlledautomatically, e.g. by robotics.

In some embodiments, a user navigates (e.g. assisted by displayedimages) the device on a desired path (e.g. within a body), for examplearound obstacles. As the path and/or movement of the joints is specifiedby the user, in some embodiments, motion of the device is less efficient(e.g. less fast, longer length of path) than that of a device controlledusing robotics where, for example, movement to position of an endeffecter in a desired position is calculated and/or optimizedautomatically.

In some embodiments, control of one or more device arm is semi-roboticwhere measured movement of user body portion/s and/or measured movementof an input device is used as a starting point for robotics calculationswhere position and/or movement of the device is calculated (e.g. usinginverse kinematics). In some embodiments, in mapping measured user bodymovement position of one or more device portion is within 30% or within20% or within 10% of a user body position. FIG. 43 is a flow chart of amethod of control of a device arm, according to some embodiments of theinvention.

At 4302, optionally, a position of a surgical device and/or user armsand/or input device arms is initialized (e.g. matched). In someembodiments, at 4302, a surgical device arm position (e.g. anglesbetween segment long axes) and a user arm position are initialized.

At 4304, user joint movement and/or input device movement is measured.

In some embodiments, once a device arm and a user arm (and/or inputdevice arm) are approximately (e.g. in some embodiments, matching isonly required once a discrepancy between user device arm positions isabove a tolerance) in the same positions, at 4304, position of at leastone user arm is measured.

At 4306, measured movement is processed. In some embodiments, processingincludes mapped of measured input object movement to surgical devicejoint movement, e.g. where user body movement is used to control thedevice, for example using a mapping of user anatomy to joint anatomy.

In some embodiments, mapping of input device movement to surgical devicemovement includes mapping of angles between of effective input devicesegments to angles between of effective surgical device segments.Described previously are different descriptions of effective surgicaldevice segments, in different embodiments, each method described in thisdocument of determining and/or measuring effective surgical devicesegments is used in mapping of input device movement to surgical devicemovement.

In some embodiments, mapped midpoints of input object device portions(e.g. midpoint/s of joint/s) are used to control a surgical device (e.g.by mapping movement of the input object device joint midpoints tosurgical device joint midpoints).

In some embodiments, mapping includes correction for discrepancy betweeninput object structure and surgical device structure.

Optionally, in some embodiments, processing includes filtering ofmeasured movement (e.g. to remove disallowed movements). In someembodiments, processing includes processing according to a control mode,for example control modes as described regarding FIG. 63A (e.g.introduction of a time delay in a timing mode).

At 4308, one or more surgical device arm is moved according to theprocessed desired device movement.

Exemplary Surgical System Including an Input Device

In some embodiments, a surgical system includes a surgical device whichis controllable by movement of an input device. In some embodiments, thesurgical device is inserted into a patient (e.g. during laparoscopicsurgery).

FIG. 44A is a photograph of a user 4464 controlling a surgical device4400 using an input device 4400 ip, according to some embodiments of theinvention.

In some embodiments, an input device includes an input device first arm4404 ip and an input device second arm 4406 ip. In some embodiments, aninput device includes less or more than two arms, for example, one arm,three arms, 2-6 arms.

In some embodiments, each input device arm controls movement of acorresponding surgical device arm, for example, input device first arm4404 ip controlling surgical device first arm 4404 ip, and input devicesecond arm 4406 ip controlling surgical device second arm 4406.

In some embodiments, an input device arm is used to control anotherportion of a surgical device, for example, an imager inserted with thesurgical device. In some embodiments, more than one arm is used tocontrol a single portion (e.g. arm) of a surgical device.

In some embodiments, the surgical device includes a first surgical arm4404 and a second surgical arm 4406. In some embodiments, the inputdevice includes a first input device arm and a second input device arm,where, for example, movement of first input device arm 4404 ip controlsmovement of first surgical arm and/or movement of second input devicearm controls movement of second surgical arm 4406 ip.

In some embodiments, a user moves an input device manually, for example,by grasping and/or guiding a portion of the input device with a userhand. In some embodiments, a user guides more than one portion of aninput device arm with the user's hand and/or arm. For example, asillustrated in FIG. 44A, user 4464 controls an input device arm radiusby grasping and/or guiding the input device radius 4424 ip with theuser's hand 4464 h while guiding the input device humerus 4416 ip withthe user's wrist and/or arm 4464 w.

In an exemplary embodiment, a user grasps a portion of one input devicearm in each hand. For example, as illustrated in FIG. 44A, a user moveseach input device arm 4404 ip, 4406 ip, by grasping and/or guiding inputdevice radiuses.

FIG. 44B is a photograph of a user 4464 controlling a surgical device4400 using an input device 4400 ip, according to some embodiments of theinvention. FIG. 44B illustrates an example where swine anatomy 4461 wasplaced inside an anatomical model 4460, a user then performed ahysterectomy using a trans-vaginal approach, with surgical device 4400by moving portions of input device 4400 ip. FIG. 44B illustrates use ofa humanoid input device and surgery where the surgical device isinserted in a non-laparoscopic direction while the surgeon 4464 is in alaparoscopic position.

In some embodiments, as described previously, a surgical system usesmeasured user body movement to control a surgical device.

FIG. 45 is a simplified schematic illustrating use of a surgical system,according to some embodiments of the invention. In some embodiments,movement of a device 4500 which has been inserted into a patient 4560(e.g. through an incision 4562) is controlled by mimicking user 4564movement.

For example, as described previously regarding FIG. 42, in someembodiments, a system includes a motion detection apparatus. In anexemplary embodiment, one or more sensor is mounted on a display (whereexemplary functionality of displays is, for example, described elsewherein this document).

FIG. 46 is a simplified schematic side view of a display 4654 includingmotion detection sensors 4658, according to some embodiments of theinvention. In some embodiments, sensors 4658 include cameras. FIG. 46illustrates an exemplary embodiment, where display 4654 displays arepresentation of the surgical device and/or images of the surgicaldevice.

Exemplary Positioning of Parts of a Surgical System

FIG. 47A and FIG. 47B are simplified schematics of a surgical system,according to some embodiments of the invention. In some embodiments,patient 4760 being treated (e.g. having surgery) is supported, at leastpartially, by a patient support surface 4780 (e.g. a surgical tableand/or a patient bed, the term patient support surface is also hereininterchangeably termed “bed”). In some embodiments, a surgical device4700, which is optionally mounted to bed 4780, is used to treat (e.g.perform surgery on) patient 4760. In some embodiments, at least aportion of surgical device 4700 is inserted into patient 4760, forexample through a natural orifice (e.g. the vagina) and/or through anincision.

In some embodiments, an input device 4700 ip is positioned in closeproximity to the patient, for example, mounted on a patient bed and/orwithin 1 m or 50 cm, or 20 cm of the patent. In some embodiments, theability to place a user (e.g. surgeon) in close proximity to the patientenables the user to be within the sterile field, and/or potentiallyreduces response time of the user in an emergency situation, forexample, potentially enabling communication of the surgeon with thepatient and/or other members of a medical team.

In some embodiments, input device 4700 ip is attached to a patient bedand/or to the floor (e.g. support 5101 ip, FIG. 51 is coupled to apatient bed and/or floor).

In some embodiments, for example, as illustrated by FIG. 47A, inputdevice 4700 ip is positioned such that the surgeon is positioned in atraditional laparoscopic surgical position e.g. in proximity to apatient torso.

In some embodiments, for example, as illustrated by FIG. 47B, inputdevice 4700 ip is positioned between a patient's legs (e.g. input device4700 ip is sized and/or shaped such that it fits between (e.g. at leastpartially splayed) patient legs. For example, in some embodiments, aninput device surgical footprint (e.g. the floor space taken by an inputdevice) is 1 cm²-1 m², or 10 cm²-50 cm², or 20 cm²-50 cm², or lower, orhigher, or intermediate ranges or areas.

For example, in an exemplary embodiment, (e.g. as illustrated by FIG.47B) patient 4760 legs are splayed, for example, where legs are held bystirrups (not illustrated) attached to bed 4780. Surgical device 4700is, for example, is inserted into patent 4760 vaginally and input device4700 ip and/or surgeon 4764 are located between patient legs.

In some embodiments, a surgical system includes a display 4764 (e.g. asdescribed in reference to display 854, FIG. 8). In some embodiments,display 4764 is positioned and/or angled to replicate a position of adisplay in a laparoscopic procedure, e.g. as illustrated in FIG. 47A. Insome embodiments, a patient body forms a display where, for example,projected onto the patient's body are image/s (e.g. from camera/sinserted into the patient and/or collected by an imager e.g. MRI, CT,ultrasound etc.).

In some embodiments, display 4764 is positioned and/or angled toreplicate an open surgery surgeon's view of the treatment, even thoughthe treatment is a laparoscopic procedure, e.g. as illustrated in FIG.47B.

Referring now to FIG. 45, in some embodiments, a device is controlled,additionally or alternatively, by measured body movement of a user. Insome embodiments, for a user to control device movement with measuredbody movement, the user is in an allowable area, for example, adesignated field of vision of camera/s detecting user body movement. Insome embodiments, a system includes indication as to the allowable area(e.g. markings on the floor, a marked and/or designated chair). In someembodiments, an allowable area is adjustable by the user (e.g. the user,in some embodiments, moves motion detection equipment to a desiredlocation).

Exemplary Control Using an Input Device

In some embodiments, a user controls the device by moving an object(herein termed “input object” or “avatar”).

In some embodiments, the position and/or movement of one or more portionof the device within the patient is controlled by the user moving anavatar of one or more portion of the device. In some embodiments, theavatar is a model, optionally miniature or enlarged, of one or moreportion of the device. Optionally, the avatar includes one or moresensor which, in some embodiments, measure the position and/or movementof the avatar. In some embodiments, movement of the avatar is measuredusing motion capture technology. In some embodiments, the avatarincludes markers and/or is coated, at least partially, in reflectivematerial, e.g. to aid motion capture. In some embodiments, the avatar ispart of a fixed control consol.

In some embodiments, the avatar is hand held and/or fixable to a tableand/or desk.

Exemplary Mapping of Input Device Movement to Surgical Device Movement

FIG. 48A is a simplified schematic side view of an input device arm 4804ip, according to some embodiments of the invention. FIG. 48B is asimplified schematic side view of a surgical device arm 4804, accordingto some embodiments of the invention. In some embodiments, input devicearm 4804 ip controls surgical device arm 4804.

In some embodiments, an input device structure has one or more ratioand/or dimension which is substantially the same as (also herein termed“matching”) a ratio and/or dimension (optionally scaled) of a surgicaldevice and, optionally, one or more other dimension and/or ratio whichdoes not match those of a surgical device.

For example, in an exemplary embodiment, a length ratio between twoeffective segment lengths of an input device and a surgical device aresubstantially the same, for example, with 0-5%, or 0-1%, or 0-0.5%, orlower or higher or intermediate ranges or values of a difference betweenthe ratios. Where an effective segment length is the length of a centrallong axis of the segment between intersections of long axes of othersegments and/or between an axis intersection and a termination of thesegment.

For example, referring to FIG. 48A: An effective length of an inputdevice arm 4800 ip humerus 4812 ip is length Hip, measured betweenintersections of humerus long axis 4813 ip with the support (e.g.support long axis 4803 ip) and radius long axis 4817 ip. An effectivelength of an input device arm 4800 ip radius 4816 ip is length Rip,measured between intersection of radius long axis 4817 ip andtermination of input device radius 4816 ip.

Potentially, an effective input device radius length corresponding to aneffective surgical device radius length which does not include a lengthof an end effecter means that accuracy of control is maintained forsurgical devices with different end effecters (e.g. different sized endeffecters).

In some embodiments, one or more matching segment length ratio betweenan input device and a surgical device enables intuitive control of thesurgical device with the input device, for example, despite structuraldifferences between the devices. For example in some embodiments, asurgical device (e.g. as described elsewhere in this document) includeslong connecting portions, whereas, in some embodiments, (e.g. asillustrated in FIG. 44A and/or FIG. 48A and/or FIG. 49A) input devicearm joints include pivots.

In some embodiments, effective segment length ratios between the inputdevice and surgical device match, but actual segment length ratios donot match. For example, in some embodiments, a surgical device includeslong connecting portions (e.g. as described in the section of thisdocument entitled “Exemplary long joints”), and an input device capableof controlling the surgical device includes short connecting portionsfor example, pivot connections (e.g. as illustrated in FIG. 48A).Potentially, an advantage being ease of control of the input device(e.g. input device segments rotate freely about pivots, e.g. inputdevice segments do not move with unwanted degrees of freedom from longjoints) and/or a surgical device which has an non-angular shape (e.g.less likely to damage patient tissue).

In an exemplary embodiment, a thickness of one or more input devicesegment (e.g. diameter of cylindrical segments and/or largest segmentcross sectional dimension) is different (e.g. larger) than to those of asurgical device. Increased input device segment thickness potentiallyprovides space for sensors and/or locking devices (e.g. as describedregarding FIG. 54A, FIGS. 55A-55B, FIG. 56, elsewhere in this document)and/or provides an input device with dimensions which are comfortableand/or easy for a user to maneuver.

In an exemplary embodiment, input device segment thickness is 20-26 cm,or 13-18 cm, or 13-26 cm, or lower, or higher or intermediate ranges orthicknesses. In an exemplary embodiment, surgical device segmentthickness is 6-8 cm, or 4-8 cm, or 4-6 cm or lower, or higher orintermediate ranges or thicknesses.

In an exemplary embodiment, a ratio between surgical device segmentthickness and input device segment thickness is 1:0.5, to 1:3, or lower,or higher or intermediate ranges or ratios.

In an exemplary embodiment, a ratio between surgical device segmentlength and input device segment length is 1:0.5, to 1:3, or lower, orhigher or intermediate ranges or ratios.

Exemplary Control of Angles Between Surgical Device Segments

In some embodiments, a measured angle and/or change in angle betweenlong axes of two input device segments, is used to control and/or changean angle between corresponding long axes of two surgical devicesegments.

In some embodiments, measurement is of a physical angle (e.g. angle α)between long axes of two device segments. In some embodiments,measurement is of a change in angle between long axes of two devicesegments.

For example, in some embodiments, an angle α′ between a long axis 4813of a surgical device humerus 4812 and a long axis 4803 of a surgicaldevice support 4802 is controlled by an angle α between a long axis 4813ip of an input device humerus 4812 ip and a long axis 4803 ip of aninput device support 4802 ip.

For example, in some embodiments, an angle (3′ between a long axis 4817of a surgical device radius 4816 and a long axis 4813 of a surgicaldevice humerus 4812 is controlled by an angle θ between a long axis 4817ip of an input device radius 4816 ip and a long axis 4813 ip of an inputdevice humerus 4812 ip.

In an exemplary embodiment, a surgical device is controlled using aone-to-one mapping of an angle between adjacent input device segmentsand corresponding adjacent surgical device segments.

Exemplary Control of Rotation of Surgical Device Segments

FIG. 48C is a simplified schematic side view of an input device arm 4804ip, according to some embodiments of the invention.

In some embodiments, rotation of an input device segment about a longaxis of the segment is used to control rotation of a correspondingsurgical device segment.

In some embodiments, measurement is of a physical angle of rotation. Insome embodiments, measurement is of a change in angle of rotation.

Exemplary Input Device Structure

FIG. 49A is a simplified schematic side view of an input device,according to some embodiments of the invention.

In some embodiments, one or more input device arm segments (e.g.segments) where adjacent segments are connected by connecting sections(e.g. joints). In some embodiments, for example, unlike some embodimentsof the surgical device, one or more arm connecting section is a pivotjoint.

In some embodiments, one or more input device arm (e.g. arm 4904 ipand/or arm 4906 ip) includes a support segment (e.g. 4902 ip, 4902 aip)coupled to a first segment (e.g. 4912 ip, 4914 ip) by a first connectingsection (e.g. 4908, 4910) where first segment (e.g. 4912 ip, 4914 ip) iscoupled to a second segment (e.g. 4916 ip, 4918 ip) by a secondconnecting section (e.g. 4920 ip, 4922 ip) and a third segment (e.g.4924 ip, 4926 ip) is coupled to second segment (e.g. 4916 ip, 4918 ip)by a third connecting section (e.g. 4928 ip, 4930 ip).

In some embodiments, one or more (e.g. all) input device segment isrotatable around a segment long axis.

In some embodiments, an angle between adjacent segment long axes(flexion) is adjustable.

In some embodiments, one or more support segment 4902 ip, 4904 ip isconnected to an input device platform 4960.

In some embodiments, an angle of support segment/s with respect toplatform 4960 is adjustable, where adjustment is, for example, duringset up of the device (e.g. arms are adjusted by a user) and/or duringuse of the input device. In some embodiments one or more input armsupport section (e.g. support section 4920 ip) is connected to platform4960 at an adjustable point on hole 4982. In some embodiments, an angleof one or more an input arm support section is initialized e.g. to beparallel or perpendicular to the floor. In some embodiments, adjustableangle of input arm support section/s enables initializing arm positionwhere, for example, the platform is angled with respect to the floor.

In some embodiments, adjustment of an angle of an input device supportsection is used to change an angle of a surgical device support segment,for example an angle of entry of the surgical device into a patient(e.g. through a port). In some embodiments, a different control methodis used to change an angle of entry of one or more portion of a surgicaldevice entering a patient (e.g. through a port and/or a naturalorifice). In some embodiments, different portions of a surgical device(e.g. different limbs) are inserted into the patient at differentangles. In some embodiments, a support segment is an elongated element,for example, where connecting portions and segments connected to thelimb support segment have a maximum length of less than 50% of a lengthof the support structure, or less than 20% (e.g. where a surgical devicelimb includes a similar structure to a traditional laparoscopic tool).

In some embodiments, a separation between input device arms 4904 ip,4906 ip is adjustable, for example, by adjustable attachment of one ormore input device arm to input device platform 4960. In someembodiments, position of one or more input device arm on a deviceplatform is adjustable in one, or two, or three dimensions. In anexemplary embodiment, platform 4960 includes slider rails 4962, and eacharm is attached to a slider 4964, 4966 which is tightened into positionon the slider rails using wing nuts 4968.

FIG. 49B is a simplified schematic side view of an input deviceincluding handles 4960, 4961, according to some embodiments of theinvention. In some embodiments, one or more input device limb includes ahandle. In some embodiments, each input device limb includes a handle.

In some embodiments, an input device is small, for example potentiallyreducing cost and/or facilitating desired positioning (close to apatient, e.g. as described regarding FIGS. 47A-47B). For example, insome embodiments a small input device limb has a maximum dimension (e.g.when straightened) of 5-100 cm, or 10-50 cm, or 10-30 cm, or lower orhigher or intermediate ranges or dimension.

In some embodiments, an input device is structured such that aconnecting section pivot point is not at an intersection betweeneffective segments. For example, referring to FIG. 48A, a connectingsection 4820 ip pivot point 4820 piv is not at an intersection betweenaxes 4813 ip and 4817 ip. In some embodiments, a pivot point (e.g. pivotpoint) 4820 piv is disposed closer to a longitudinal center point thesegments pivoting around the pivot point (e.g. segments 4 av 12 ip, 4816ip) than the intersection of the axes of the segments (e.g. intersectionbetween axes 4813 ip and 4817 ip). Potentially, an input devicestructure where the pivot points between segments are disposed closer toa longitudinal center point of the segments rotating around the pivotpoint matches surgical device structure where joints between segmentsare long. In some embodiments, pivot points enable bending of 180°and/or more than 180°.

In some embodiments, an input device includes one arm. In someembodiments, an input device includes two arms, or more than two arms.In some embodiments, an input device includes an arm for each insertedsurgical device arm. For example, in some embodiments, an input deviceincludes an arm for each mechanical surgical device arm and anadditional input device arm for control of a camera (e.g. camera 1078FIG. 10A).

Exemplary Input Device

In some embodiments, the user controls the device using a handheldcontroller. FIG. 50A is a simplified schematic of a controller 5007,according to some embodiments of the invention. FIG. 50B is a simplifiedschematic of a controller 5070 held by a user, according to embodimentsof the invention.

In some embodiments controller 5070 includes a stylus 5072 coupled to awrist attachment 5074. Referring to FIG. 50B, in some embodiments,stylus 5062 is held between user fingers 5064F (e.g. like a pen). Insome embodiments, a portion of wrist attachment 5074 sits in a user palmand a portion of the wrist attachment is fixed to a user wrist 5064W. Insome embodiments, movement of the stylus is mimicked by a device arm. Insome embodiments, the angle between the stylus and wrist attachment 5074controls device arm elbow flexion. In some embodiments changing thewrist angle will control the device shoulder flexion.

In some embodiments, controller includes a hand tool 5024 (e.g. agripper). In some embodiments, hand tool 5024 is coupled to stylus 5072by a joint 5076, for example, a universal joint. In some embodiments, auser controls the hand tool by moving the hand tool at the joint.Alternatively or additionally, in some embodiments, a user controls thehand tool using one or more user control (e.g. button) on the stylus.

In some embodiments, a user controls device movement using, for example,voice activated control/s, user motion which is not mimicked (e.g. legs,fingers) a joystick, a mouse, a keyboard, one or more foot control (e.g.a foot pedal).

Exemplary Input Device Including a Handle

In some embodiments, an input device arm includes one or more handle. Insome embodiments, a user moving the input device arm (e.g. in order tocontrol movement of a corresponding portion of the surgical device)grasps a handle.

FIG. 51 is a simplified schematic side view of an input device armincluding a handle 5160, according to some embodiments of the invention.

In some embodiments, a user grasps handle 5160 with one hand, forexample, in some embodiments, the user controlling two input devicearms, one with each hand.

In an exemplary embodiment handle 5160 includes a gun shape with abarrel portion 5162 and a grip portion 5164 (e.g. handle 5160 is alaparoscopic tool handle, in some embodiments, other laparoscopic toolhandles of the art are used for handle 5160). Where, for example, barrelportion 5162 has a barrel long axis 5166 which is parallel (e.g.collinear) to a long axis 5117 ip of an input device radius 5116 ip.

In some embodiments, a long axis 5168 of grip portion 5164 includes acomponent which is perpendicular to barrel portion long axis 5166, forexample, grip portion long axis 5168 being at an angle θ 45-135°, or70-110° or about 90°, or lower or higher or intermediate ranges or tobarrel portion long axis. In some embodiments, barrel portion long axisand grip portion long axis are co-planar.

In some embodiments, grip portion 5164 is sized and shaped to be gripedcomfortably by a user hand, for example, with a rounded cross sectionwhere a maximal cross sectional dimension of grip is 2-8 cm.

A potential benefit of handle 5160 is a comfortable user control, whistmaintaining an intuitive relationship between geometry of the inputdevice and the surgical device (e.g. one or more limb length ratios ofthe input device is substantially the same as an input ratio of thesurgical device). A further potential benefit of handle 5160 is theability to make the input device small while maintaining user ability tomove the input device in a desired way (e.g. smaller than is comfortableand/or easy for a user to control movement of).

FIG. 52A is a simplified schematic side view of an input device armincluding a handle, according to some embodiments of the invention. FIG.52B is a simplified schematic side view of a surgical device arm,according to some embodiments of the invention. FIG. 52A and FIG. 52Billustrate control of surgical am by input device, where angles of inputdevice long axes substantially match segment long axes of surgicaldevice.

Exemplary User Interface/s

In some embodiments, a system includes one or more user interface, forexample, in some embodiments, an input device includes one or more userinterface.

In some embodiments, one or more input device user interface is mountedon an input device arm, for example, such that, a user gripping the arm,uses the user interface whilst maintaining a user hand position. Forexample, referring back to FIG. 44A input arm 4404 ip includes a button4462 which, in FIG. 44A user 4464 is using (the user's finger is inposition to press button 4462) whilst holding input device arm 4404 ip.In an exemplary embodiment, button 4462 is coupled to a spring loadedlever where depression of button 4462 causes a coupled portion torotate. In some embodiments, a rotation sensor senses the extent ofrotation.

Exemplary user interfaces include push button/s, slide button/s, scrollwheel/s, touch sensitive buttons and/or LCD displays.

In some embodiments, a user interface mounted on an input device acontrols an end effecter, for example, opening and/or closing of an endeffecter (e.g. opening and/or closing of an end effecter with opposingportions e.g. scissors, gripper). For example, in an exemplaryembodiment, a signal from the rotation sensor associated with button4462 is used to control a corresponding end effecter.

For example, referring back to FIG. 44A, in some embodiments, button4462 controls opening and closing of a surgical device end effecter4424.

In some embodiments, a user depresses button 4462 to change an endeffecter 4424 configuration (from open to closed, or from closed toopen). In some embodiments, an extent of depression of button 4462controls an extent of opening of end effecter 4424. Where, for example,full depression of button 4462 relating to end effecter 4424 being fullyopen and/or lack of depression of button 4462 relating to end effecter4424 being closed, and/or an extent of depression of button 4462relating to an extent of opening of end effecter 4424. In someembodiments, button

Additional exemplary user interface buttons are illustrated in FIGS.48A-48B button 4862, FIG. 49A buttons 4962, 4964 and FIG. 51 buttons5166, 5164.

In some embodiments, a user interface button returns to an originalstate when a user ceases to apply pressure to the button (e.g. a springloaded button). Optionally, a button returning to an original statereturns a surgical device end effecter to an original state.Alternatively, in some embodiments, a button remains in position (e.g. adepressed and/or semi-depressed position) until a user releases thebutton.

In an exemplary embodiment, relative movement of a button 5166 is usedto control actuation of an end effecter. In some embodiments, a userpresses on button 5166, to open and close a corresponding surgicaldevice arm end effecter.

In an exemplary embodiment, scroll button 5165 is a coupled to a rodwhere a rotation sensor measures the rotation of button 5165. In someembodiments, scroll button 5165 is used to control opening and/orclosing of an end effecter. In some embodiments, one or more button(e.g. scroll button 5165) controls a camera inserted with the mechanicalarm/s and/or a display of collected images.

In some embodiments, rotation of a corresponding surgical device endeffecter about an end effecter long axis and/or around a long axis of asegment to which the end effecter is coupled is controlled by rotationof handle 5160 about axis 5166. Alternatively or additionally, in someembodiments, rotation of a corresponding surgical device end effecter iscontrolled by rotation of button 5165. In some embodiments, a bothrotation of handle 5160 about axis 5166 and button 5165 control rotationof a corresponding surgical device end effecter, for example, enabling auser to avoid and/or move out of uncomfortable and/or un-ergonomichandle positions.

I don't know if it is described well—rotation of the gripper can becontrolled both by rotation of the handle (5160) around axis 5166, or byrotation of knob 5165.

Therefore the surgeon operates the handle as a laparoscopic handle, andif he reaches an un-ergonomic posture he can use knob 5165 to change therotation of the handle to a more comfortable position.

In some embodiments, a user manually moves one or more portion of aninput device to operate an end effecter. For example, in someembodiments, an input device includes a scissors, and a user manuallyopens and closes the scissors, for example, controlling opening andcontrolling of a surgical device scissors. In some embodiments, an inputdevice includes a plurality of portions coupled to a distal end of aninput device limb and, for example, movement (e.g. manual movement) ofone or more of the portions controls movement of corresponding portion/sof a surgical device end effecter.

Exemplary Scaling Using an Input Device

In some embodiments, an input device arm/s include portion/s which arethe same size or larger than surgical device arms. In an exemplaryembodiment, a ratio of a segment effective length of an input device toa segment effective length of a surgical device is between 5:1 and 1:1,or between 3:1 and 1:1, or lower or higher or intermediate ranges orratios. Potentially, a system including larger input device arms thansurgical arms, assist a user in fine movement control of the surgicaldevice. In some embodiments, a surgical system includes different sizedinput device arms and/or different sized surgical device arms. Forexample, in some embodiments, depending on the surgery (e.g. dimensionof surgical movements in a surgery) and/or user preference, a userselects an input device arm size. For example, in some embodiments, aninput device includes different sized arms, for example, the armscontrolling surgical device arms of the same size. For example, in someembodiments, a user selects surgical device arm/s and then selects aninput device size (e.g. from a kit of different sized input devicearms). In some embodiments, a user changes input device during atreatment (e.g. surgery), for example, changing an input device to alarger device when fine surgical movements are required.

In some embodiments, a user manually controls scaling of user handmovements on the surgical device. In some embodiments, a user cangenerate larger or smaller movements of a distal end of an input devicearm radius (e.g. relating to a position of a surgical device endeffecter) for the same hand movement, by selecting a portion of theradius to grasp: For example, movement of a user's hand grasping aninput device arm at and/or close to the distal end of the input deviceradius (e.g. as illustrated in FIG. 44A), generates a smaller movementof the distal portion of the radius than the same than the same handmovement when a user grasps the input device radius more proximally(closer to the connection between the radius and humerus).

In some embodiments, a handle attached to a segment which the user usesto move at least a portion of the input device (e.g. a handle, forexample, as described in the previous section “Exemplary input deviceincluding a handle”) provides scaling of user movements. For example, insome embodiments, the handle extends distally of an input devicesegment, meaning that large user hand movements are translated tosmaller movements of the proximal end of the segment to which the handleis attached.

Exemplary Input Device with Adjustable Scaling

In some embodiments, an input device includes adjustable scaling, where,for example, user movement (e.g. user hand movement) is scaled bydifferent amounts

Handle slides to change distance from handle to gripper FIG. 53A is asimplified schematic side view of an input device arm 5304 ip includinga handle 5360, according to some embodiments of the invention. FIG. 53Bis a simplified schematic side view of an input device arm 5304 ipincluding an extended handle 5360, according to some embodiments of theinvention. In some embodiments, a separation of handle 5360 from segment5316 ip is increased (e.g. from separation L illustrated in FIG. 53A toseparation L′ illustrated in FIG. 53B), meaning user movements of thehandle translate to smaller movements of segment 5316 ip.

In some embodiments, possible amount of separation of the handle iscontinuous from a minimum to a maximum and, for example, a user selectsthe amount of separation. Alternatively, in some embodiments, discreteamounts of separation of the handle are provided by input device arm 11av 094 ip.

Exemplary Input Device Connecting Portions

FIGS. 54A-54B are simplified schematic side views of a portion of aninput device arm 5404 ip including a connection 5408 ip between inputdevice segments 5412 ip, 5415 ip, in different configurations, accordingto some embodiments of the invention.

As described elsewhere in this document (e.g. as described regardingFIG. 48C, FIG. 49A), in some embodiments, input device segments arerotatable around a segment long axis, for example, rotation of secondsegment 5412 ip about a segment central long axis, in a direction D1transfers the portion of input device arm 5404 ip illustrated in FIG.54A to the configuration illustrated in FIG. 54B.

In some embodiments, one or more connection between adjacent inputdevice arm segments includes a pivot connection. In some embodiments,flexion of adjacent segments with respect to each other is about pivotconnections. For example, first segment 5412 ip rotating around pivotconnection 5408 ip in a direction D2 transfers the portion of the inputdevice arm 5404 ip illustrated in FIG. 54B to the configurationillustrated in FIG. 54C.

Exemplary Measurement of Input Device Movement

In some embodiments, sensor/s mounted on and/or within the input devicemeasure input device movement, and this measured movement is used tocontrol movement of the surgical device.

In some embodiments, one or more portion of an input device includes asensor. In some embodiments, one or more input device segment includes asensor which measures rotation of the segment. In some embodiments, theinput device includes one or more sensor which senses an extent offlexion of one or more input device joint.

Referring back to FIG. 54A, in some embodiments, motion sensors aremounted on input device connecting portions. In some embodiments, one ormore sensor senses rotation of first segment 5412 ip around pivot axis5470, sensor/s, for example, producing a signal corresponding to flexionof first segment 5412 ip with respect to segment 5404 ip. In someembodiments one or more sensor senses rotation of second segment 5412 ipabout a segment long axis (not illustrated in FIG. 54A).

In some embodiments, a connecting portion includes two brackets, abracket connected and flexing with each segment, the brackets connectedtogether at a pivot point around.

In an exemplary embodiment, connecting portion 5408 ip includes anexternal bracket 5472 coupled to first segment 5412 ip, which pivotsaround an internal bracket 5474. In some embodiments, second segment5412 ip is coupled to internal bracket 5474 and is rotatable withininternal bracket 5474.

In an exemplary embodiment, segment 5404 ip is coupled to a shaft gear5476 where shaft gear 5476 rotates with segment 5416 ip, within innerbracket 5474, for example, shaft gear 5476 sliding within inner bracket5474 when segment 10 av 16 ip rotates. Outer bracket 5472 includes firstand second gears 5478, 5479. In some embodiments, first and second gears5478, 5479 which rotate with flexion of second segment 5412 ip withrespect to first segment 5412 ip.

In some embodiments, shaft gear 5476 interfaces with first and secondgears 5478, 5479, rotation of shaft gear 5476 about segment 5404 ip longaxis causing first gear 5478 and second gear 5479 to rotate in differentrotational directions about axis 5470. In some embodiments, flexion ofsegments 5412 ip, 5414 ip with respect to each other causes first andsecond gears 5478, 5479 to rotate in the same rotational directionaround axis 5470.

In some embodiments, connecting portion 5408 ip includes two sensors.For example, in an exemplary embodiment, a first sensor 5482 connectedto (e.g. mounted on and/or within) outer bracket 5472 senses rotation(e.g. direction and/or amount of rotation) of first gear 5478 and asecond sensor 5484 senses rotation of second gear 5479. In someembodiments, two sensors, each sensor sensing rotation of one of firstand second gears 5478, 5479 provides sufficient information to measureboth flexion of segments with respect to each other 5412 ip, 5416 ip,where both gears 10 av 78, 5479 rotate in the same direction androtation of second segment 5474 around a segment long axis where gears10 av 78, 5479 rotate in different directions.

Alternatively, in some embodiments, each input device arm segmentincludes at least one sensor sensing rotation of the segment andadditional sensor/s sense flexion between segments.

In an exemplary embodiment, sensors 5482, 5484 are magnetic differentialencoders (e.g. rotor encoder/s), where, for example, a sensor senses aposition of a magnet mounted on the gear. Other motion sensors, e.g.optical encoders are envisioned and encompassed by the invention.

In some embodiments, each connection between each adjacent segment pairof the input device includes a connecting portion as described withrespect to FIG. 54A. In some embodiments, sensor outputs from more thanone connecting portion are used to determine flexion and/or rotation atof segment/s, for example, in the circumstance where segmentsconcurrently flex and rotate.

Referring back to FIG. 51, in some embodiments position sensors includeelectrical connectors 5164. Where connectors 5164, for example, transmitsignal/s from position sensors (e.g. wirelessly and/or connectors areconnected using wires and/or cables).

Exemplary Input Device Locking Mechanism/s

In some embodiments, an input device includes one or more lockingmechanism. In some embodiments, a user locks one or more portion of aninput device.

For example, in some embodiments, during a procedure, a user desires oneor more surgical device portion to remain stationary while othersegment/s are moved, the user locks corresponding input device portion/sin position and then continues to move other portions of the surgicaldevice, using the input device.

For example, in some embodiments, upon a safety alert, a user manuallyand/or a system automatically locks one or more portion of the inputdevice, for example preventing further movement of the surgical device.In some embodiments, locking is into a last position. In someembodiments, locking is into a homing position (e.g. input device movesinto a homing position and then locks in that position).

For example, in some embodiments, when a user lets go and/or loosesgrasp on and/or takes a break from controlling the input device, one ormore portion of the input device is manually and/or automatically lockedin position. For example, in some embodiments, an input device includesone or more sensor detecting an amount (e.g. area of contact and/orstrength and/or pressure of contact) of user contact with the inputdevice (e.g. pressure sensor). In some embodiments, upon detection (e.g.by comparison of sensor signal/s with a threshold, where the thresholdis e.g. stored in a memory) of a loss of contact and/or insufficientcontact, the input device is automatically locked (e.g. a processorreceiving sensor signals generates and/or sends command signals to inputdevice locking mechanism/s).

In some embodiments, a single locking mechanism, when in a lockedconfiguration, prevents rotation of a segment and flexion betweenadjacent segments. In some embodiments, a locking mechanism is locatedat a connection between two segments.

In some embodiments, a locking mechanism includes one or more elementwhich prevents rotation of one or more of gears 5476, 5478, 5479 FIG.55A is a simplified schematic side view of an input device armconnecting portion 5508 ip including a locking element in an unlockedconfiguration, according to some embodiments of the invention. FIG. 55Bis a simplified schematic side view of a portion of an input device armconnecting portion 5508 ip including a locking element in a lockedconfiguration, according to some embodiments of the invention.

In an exemplary embodiment, a locking element 5586 locks first andsecond gears 5578, 5579 e.g. preventing rotation of the gears 5578,5579. In some embodiments, locking element 5586 is connected to outerbracket 5572.

Referring to FIG. 55B, where locking element 5586 is in a lockedconfiguration. In some embodiments, locking element 5586 includes a gearfixed to outer bracket 5572 that prevents first and second gears 5578,5579 from rotating. In some embodiments, stationary first and secondgears 5578, 5579 prevent shaft gear 5576, (and, in some embodiments,segment 5516 ip) from rotating.

In some embodiments, locking element is moved between locked andunlocked configurations manually, for example, by a user pushing theelement manually. In some embodiments, an actuator moves locking element5586 (e.g. automatically and/or upon receipt of a user input).

In some embodiments, a single locking mechanism (e.g. 5586) at eachconnecting portion is able to lock rotation and flexion of all inputdevice segments. A potential advantage being reduced size and/orcomplexity of the input device arms.

Alternatively, in some embodiments, each connecting portion includesmore than one locking mechanism, for example, a mechanism to preventrotation of a segment and another mechanism to prevent flexion of thesegment.

A potential advantage of a gear locking element is the high resistiveability of the lock, providing a secure lock. However, gear locking, insome embodiments, provides a discrete number of locking positions.

FIG. 56 is a simplified schematic side view of an input device armconnecting portion 5608 ip including a locking mechanism, according tosome embodiments of the invention. In some embodiments, a lockingmechanism prevents rotation of at least one of gears 5676, 5678, 5679.

In some embodiments, a first locking element 5686 is used to preventrotation of first gear 5678. In some embodiments, first locking element6286 is an element which is tightened around a shaft (not visible inFIG. 56) connected to first gear 5678 and increased friction betweenlocking element 6286 and the shaft, when, for example, locking element5686 is tightened around the shaft.

In an exemplary embodiment, each of first and second gears 5678, 5679 islockable using first and second locking elements 5686, 5688respectively. A potential benefit of locking two of the gears, isincreased strength of locking. In some embodiments, shaft gear 5676 isalso locked by a locking mechanism.

In an exemplary embodiment, second locking element 5688 has a shapewhich partially surrounds a shaft connected to second gear 5679 andsecond gear is locked in position by pulling locking element ends 5690,5692 towards each other e.g. by pulling wire/s (not illustrated)attached to ends 5690, 5692. A potential benefit of locking elements5688, 5690 is the ability to lock the joint in any position (e.g.continuous locking). However, locking strength, in some embodiments, islimited by the frictional force between the locking element (e.g. 5688)and the portion onto which the locking element is tightened (e.g. axle5691).

Exemplary Control by Mimicking User Body Movement

In some embodiments, movement of one or more portion (e.g. joint) of adevice arm is controlled by measured movement of a corresponding portionin a user arm (e.g. a device joint movement controls movement of thecorresponding device joint). In some embodiments, the anatomical nameused in this document for a device portion is the name of acorresponding portion in a user when user movement is used to controlthe device.

In some embodiments, a position of segments of a device arm with respectto each other (angles between segment long axes) is controlled by aposition of segments of a user arm with respect to each other (e.g.positions of the device arm and user arm are matched).

In some embodiments, device and arm position (angles between segmentlong axes) are aligned in an initialization process and positionmatching and/or control is maintained by movement control. For example,if the device arm and user arm start in the same position and usermovements are accurately mapped to the device, the arms remain in amatched position. In an exemplary embodiment, both movement of thedevice and position of device segments are controlled by measured usermovement. Referring to FIG. 58, images B1-B4 illustrate a device armwhere the arm and device position are controlled by measurements of auser arm (images A1-A4).

FIG. 58 is a series of photographic illustrations showing movement of auser and of a device arm, according to some embodiments of theinvention.

A1 shows an outstretched user arm and B1 shows a device arm mimickingthis arm orientation with approximately 180° between a long axis of thedevice humerus and a long axis of the device radius. In order to movefrom the position in A1 to that in A2, the user bends their arm at theelbow (elbow flexion). B2 shows the device arm mimicking this armorientation with approximately 90° between the humerus long axis and theradius long axis. In order to move from the position in A2 to that inA3, the user rotates their humerus in a forwards (of the user) direction(medial rotation).

B3 shows the device arm mimicking this arm orientation by rotating thedevice humerus by approximately 90°. In order to move from the positionin A3 to that in A4, the user rotates their hand, such that their palmis facing forwards of the user (wrist pronation). B3 shows the devicearm mimicking this arm orientation by clockwise rotation of the radiusby approximately 90°.

Optionally, in some embodiments, a device camera position with e.g.respect to device arms is controlled by a user head position e.g. withrespect to user arms. In some embodiments, device camera position isselectively controlled by user head movement, for example, allowing auser to turn their head e.g. to view a display, without moving thedevice camera. In some embodiments, mimicking of a user head position iswithin a range of positions. In some embodiments head movements arefiltered before being used to control the camera (e.g. rapid and/orunexpected user head positions are not mimicked by the device camera).

Exemplary Measurement of User Movement

In some embodiments, for example, in order for a user to control thedevice, user arm movement is measured, (e.g. by measuring positionand/or orientation of arm portion/s repetitively). In some embodiments,measurement is using motion capture technology (e.g. using one or moreinfrared motion detection camera). FIG. 58 illustrates control of adevice arm using motion capture technology, according to someembodiments of the invention. In FIG. 58, measured joint positions areillustrated as white circles on images A1-A4.

In some embodiments, images of one or more user arm are captured. Insome embodiments, measurement includes extracting the position and/ormovement of joints, e.g. position and/or movement of joints in 3D space,position and/or movement of joints with respect to each other. In someembodiments, joints are modeled as points and/or regions in space, whichare, for example, extracted from images.

Alternatively or additionally, in some embodiments, one or more otherarm parameter is measured, for example, movement of one or more segment,angles between segments. For example, in some embodiments, one or moresegment is modeled by a segment long axis line in space, which line is,e.g., extracted from images. For example, in some embodiments, anglesbetween segments and/or change in angles between segments, are measured(e.g. extracted from images).

In some embodiments, measurement of user arm position is assisted byplacing markers onto the user (e.g. reflective markers), for example, atthe joint, as is known in the art of motion capture. In an exemplaryembodiment, markers are 4 mm spheres. In an exemplary embodiment,Kinect™ motion capture technology is used.

Additionally, or alternatively, in some embodiments, one or more sensor,for example, affixed to the user measures user body position and/ormotion (e.g. a position sensor, a motion sensor).

FIG. 59A and FIG. 59B are simplified schematic illustrations of bodypoints the position and/or movement of which are measured, according tosome embodiments of the invention. In some embodiments, upper bodypoints (e.g. position of joints) are measured, for example, asillustrated in FIG. 59A. In some embodiments, body points includingpoints on the upper body (e.g. including the head) and/or lower body aremeasured, for example, as illustrated in FIG. 59B.

In some embodiments, a user holds a tool avatar (e.g. scissors, grasper)and measurements of tool position and/or orientation and/or movementand/or actuation (e.g. opening, closing) are measured (e.g. using motioncapture) and used to control a device tool (e.g. hand tool). In someembodiments, a measured orientation of a tool avatar is used to measureuser wrist rotation. In some embodiments, a tool avatar includes areflective coating to aid motion capture.

Exemplary User Motion Control Positions, e.g. Seated or Standing

In some embodiments, a user controls a surgical device with user bodymotion when the user is in a seated position. In some embodiments, theuser is standing. Other exemplary positions include such as leaning on asupport (e.g. desk and/or wall). In some embodiments, motion detection(e.g. implemented by a processor e.g. processor 4216, FIG. 42) istailored depending on the user position (e.g. if the user is seated orstanding).

As is described in more detail below, in some embodiments, transitionbetween a seated and a standing position is used to change mode of thesystem

In some embodiments, detection of whether a user is seated or standingis based on a measured height difference between a measured position ofthe spine and/or a measured distance between the center of the hips tothe feet, and/or distances between other body parts.

Exemplary Mapping of Measured User Movement

In some embodiments, measurements of user limb/s are mapped to thedevice for control of the device. In some embodiments, user arm portions(e.g. segments and/or joints) are mapped to corresponding deviceportions. In some embodiments, mapping is automatic and extractedmeasurement of movement of a portion is automatically mapped to theanatomic equivalent (e.g. radius to radius, humerus to humerus) forcontrol. Alternatively, in some embodiments, a mapping of measured usersegments to device segments is defined by the user, before and/or duringuse of the device. For example, in some embodiments a user sets controlof a device shoulder joint by the user hand segment, for example, forease of control e.g. when the shoulder joint is near a delicate tissueportion.

In some embodiments, e.g. once a user arm portion is mapped to a devicearm portion, measured movement of the user portion is mapped for controlof movement of the device portion.

In some embodiments, one or more ratio between device arm segments areapproximately the same as human ratios (e.g. a length of a radiussegment is 20% shorter than a length of a humerus segment) and, forexample, one or more part of a mapping between measured user armmovements and device arm movement is a scale. For example, in someembodiments, the device segments lengths are approximately a scaled downversion of human arm segments lengths and user arm movements are, forexample, scaled down to the device for control of the device.

For example, in some embodiments, a device arm has a length (excludingthe torso) which is a tenth of a user arm length (excluding the torso),where length is measured as a long axis length of the arm (both user anddevice) when straight, from where the humerus meets the torso to thedistal tip of the hand tool and/or radius. Then, in some embodiments,if, for example a distal end of the user radius is moved 10 cm in an xdirection, then the distal end of the device radius is correspondinglymoved 1 cm in the x direction.

In an exemplary embodiment, movement of user joints is measured. Fromthe joint measurements angles and/or changes in angle between usersegments are calculated. In some embodiments, the calculated anglesand/or changes in angle are used to control device, segment movement,for example, a 10° increase in angle between two user arm segmentscorresponding to a 10° increase in angle between the correspondingsegments in the device arm, the distance moved by the device segmentsbeing scaled correctly.

In some embodiments, measured movements of different portions of a userare mapped for device control using different mappings. For example, insome embodiments, a mapping for control of a device end effectors is adifferent mapping that that for control of other device portions, e.g.for reduced movement of some device portions.

In some embodiments, for example, as different human arms have differentratios between segments, a device is calibrated to an individual user(e.g. before the user starts using the device). In some embodiments, auser arm length is measured by measuring a length of user arm segmentswhen the user's arm is straight. For example, when a user arm is heldstraight, measured joint positions (e.g. in 3D space) provide lengths ofsegments between the joints. In some embodiments, prior to using thedevice in treatment, the system performs an automatic calibrationbetween a user arm (or arms) and a device arm (or arms).

In some embodiments, human arms and device arms have different segmentratios (e.g. device, is crab-like with a longer radius than humerus)and, for example, the device is moved with relative movements (asdescribed elsewhere). For example, in some embodiments, a device withdifferent ratio segments is controlled by moving a device end effectorsaccording to position and/or movement of a user hand, while usingmeasured user elbow and shoulder joint position and/or movement as astarting point for robotics control of other device joints.

In some embodiments, device control includes more than one mapping mode.In a first mode, for example, for rough positioning movements, thedevice mimics user segment angles with a 1:1 mapping. In an alternativemode, for example, for fine work (e.g. surgery once the device ispositioned), larger user gestures are used to control fine devicemovements, for example, in some embodiments a 20° deflection of a user'shumerus about a shoulder joint results in a 2° deflection of a devicehumerus.

In some embodiments, a user selects a fine work mode by moving arms to adesignated position, e.g. to an arm rest.

Exemplary Initialization

In some embodiments, during initializing, the user matches user armand/or input device arm position (arm position e.g. as defined above) toa surgical device arm position (optionally for two user arms and twodevice arms, each user arm corresponding to a device arm).

For example, in some embodiments, the user views an image of the device,and moves their arm/s (and/or input device arms) to copy an orientationof the surgical device arm. In some embodiments, the user receivesfeedback e.g. visual on the display and/or audio, to guide matching ofthe user arm/s (and/or input device arms) to the surgical device arm. Insome embodiments, the user matches two arms simultaneously.

In some embodiments, a surgical device arm position is matched to a userarm position (and/or to an input device arm position). For example, oncea user arm (and/or an input device arm) is in a desired position, thesurgical device arm moves (e.g. automatically) into a position wherepositions of surgical device arm joints and/or angles of segments withrespect to each other and/or orientation of the device arm mimic theuser arm (and/or the input device arm). In some embodiments, wheninitializing a device-user arm pair, one portion of the surgical devicearm remains static in space (e.g. the torso/s and/or the end effecter/s)and the other portion/s move to initialize the surgical device to userposition (and/or input device position). In some embodiments, a userdefines the static portion.

Optionally, initializing of a surgical device arm is automatic, forexample, by using robotics (e.g. kinematics and/or motion constraints).

In some embodiments, for example, before insertion of the surgicaldevice into a body, a surgical device is initialized to a specific useranatomy. For example, one or more segment length is adjustable. Forexample, in some embodiments, one or more segment length is adjusted,e.g. so that segment ratios are the same as a user's limb segment ratio.For example, in some embodiments, one or more segment length isadjusted, e.g. so that the segment and/or a ration of two segmentlengths matches that of an input device.

In some embodiments, for example, if mapping of movement of the surgicaldevice is not fully accurate, during use (e.g. during a treatment and/orsurgery), the surgical device arms are re-initialized after a timeduration and/or number of movements and/or distance moved.

In some embodiments, a user origin (and/or an input device origin) formeasurement of user orientation and/or a device origin are set. Forexample, in some embodiments, a device orientation in space is matchedto a user orientation in space (and/or an input device orientation inspace).

In some embodiments, a system including surgical arm/s is able torecognize when the arm/s are in a straight and/or initialized position.For example, the arm/s include sensor/s and a processor receiving thesensor signal/s infers a position from the signal/s, in someembodiments, identifying if the arm/s are straight.

In some embodiments, for example, before a treatment is carried outusing a surgical device, a surgical device and input device areinitialized. In some embodiments, initializing of an input device to asurgical device includes aligning structural configurations (e.g. anglesbetween long axes of segments) of the input and surgical devices. Insome embodiments, for example, once structural configurations arealigned (e.g. during initialization and/or re-initialization) a sensorsinitial point is set.

In some embodiments, surgical device arms are initialized to a straightposition, segment long axes are parallel (e.g. collinear). In someembodiments, surgical device arms are provided in a straight positione.g. factory calibrated to a straight position. In some embodiments, ajig is used to straighten surgical device arm/s.

In some embodiments, for example, before a surgical system (e.g. system4250 illustrated in FIG. 42) is used, input device arm/s are initializedusing a jig. For example, in an exemplary embodiment, a jig is used tostraighten input device arm/s to match straight surgical device arm/s.

FIG. 60A is a simplified schematic side view of a surgical device arm ina straight configuration, according to some embodiments of theinvention. FIG. 60B is a simplified schematic side view of an inputdevice arm straightened by a jig 6082, according to some embodiments ofthe invention.

In some embodiments, jig 6082 includes one or more element shaped tostraighten input device arm 6004 ip when the jig is pressed against theinput arm. In some embodiments, jig 6082 includes one or more hollowinto which at least a portion of input device arm 6004 ip fits.

In some embodiments, jig 6082 includes a hole or handle 6084, forexample, to aid a user holding and/or carrying and/or using the jig.

Exemplary Re-Initialization

In some embodiments, the surgical device does not include any motionsensors and/or does not provide feedback as to the configuration (e.g.angles between segments etc.) of the surgical device.

In some embodiments, surgical device arm/s and input device arm/s arere-initialized (e.g. matching angles between long axes). In someembodiments, re-initialization is carried out in the event of systemerror/s, for example mechanical problem/s in the surgical and/or inputdevice arms and/or electrical problems (e.g. in motor/s and/or sensors.

FIG. 61 is a flow chart of a method of re-initialization, according tosome embodiments of the invention.

FIG. 62A is a simplified schematic side view of a surgical device arm6204, according to some embodiments of the invention. FIG. 62B is asimplified schematic side view of an input device arm 6204 ip unalignedto the surgical device arm of FIG. 62A, according to some embodiments ofthe invention. FIG. 62C is a simplified schematic side view of an inputdevice arm 6204 ip realigned to the surgical device arm of FIG. 62A,according to some embodiments of the invention.

At 6100, in some embodiments, a difference between a configuration ofthe surgical device and that of an input object (e.g. input deviceand/or user body portions) is detected.

In some embodiments, a user detects the difference, for example visuallyidentifying a difference in the configuration of surgical arms (e.g. asviewed using an image inserted with the surgical device and/or a modelof the surgical arms displayed on a display).

In some embodiments, the surgical system automatically detects thedifference, for example, based on a discrepancy between sensed inputobject configuration and a model of surgical device configuration (e.g.based on motor movements of the surgical device).

For example, referring to FIGS. 62A-62B, which illustrate a 90°difference in orientation of an input device radius 6216 ip with respectto the orientation of a surgical device arm radius 6216.

At 6102, in some embodiments, once a difference (e.g. a difference overa threshold value, for example, determined by processor 4216, FIG. 42)between an input object and surgical device configuration is detected,control of surgical device movement by the input device is paused, forexample, by a user manually inputting a “pause” instruction into a userinterface and/or automatic pausing (e.g. initiated by processor 4216,FIG. 42).

At 6102, a configuration of the input object is aligned to that of thesurgical device.

For example, referring to FIG. 62A and FIG. 62C, where an orientation ofinput device radius 6216 ip has been aligned to the orientation ofsurgical device radius 6216.

In some embodiments, alignment is by a user manually moving the inputobject (e.g. the user manually moves an input device, the user moves theuser's body), optionally where the user is guided by displayed images(e.g. actual and/or modeled image of the surgical device) and/orinstructions.

In some embodiments, at least a portion of an input device isautomatically aligned, for example, by actuator/s on the input device(e.g. controlled by a processor) and/or by a separate aligning device.

In some embodiments, an input device is used to calibrate a processorassociated with actuation of the surgical device with the surgicaldevice arms. For example, in some embodiments, calibration is performedupon a mis-match (e.g. due to a mechanical problem and/or loss of power)between a real orientation of surgical device arm/s and an orientationof arms stored in a memory (e.g. orientation of arms derived from, forexample, actuation control signal/s). In some embodiments, a user alignssurgical device arm/s to the a stored arm configuration using an inputobject (e.g. input device).

At 6102, in some embodiments, after the input device and surgical deviceare realigned, control of movement of the surgical device by movement ofthe input device is resumed.

In some embodiments, initialization and/or alignment of an input devicearm is used in changing which input device arm controls which surgicaldevice arm. For example, in some embodiments, an input device includesfewer arms than there are surgical arms, for example, in someembodiments, five surgical device arms are controlled using an inputdevice with two arms.

In some embodiments, when a user changes which surgical device arm iscontrolled by an input device arm, in some embodiments, the respectivearms are aligned and/or initialized, for example, in some embodiments,the input device arm automatically moving to a position of the newsurgical device to be controlled.

In some embodiments, more than one surgical device is controlled usingan input device and/or mechanical arms inserted through differentincisions are controlled by an input device. For example, in someembodiments, an input device controlling movement of mechanical arm/swhich have been inserted into a patient transvaginally is then used tocontrol mechanical arm/s which have been inserted into the same patient(e.g. concurrently inserted) through an incision in the abdomen (e.g.through an incision in the umbilicus).

In some embodiments, more than one input device (and/or input objecte.g. measured user body movement) is used to control one or moresurgical devices, for example, enabling more than one surgeon to operateon a patient e.g. at the same time e.g. sequentially.

Alternatively or additionally to moving the input device, in someembodiments, aligning the input device and surgical device includesmoving one or more portion of the surgical device.

Additionally or alternatively, in some embodiments, re-initialization(e.g. as described in this section) is between one or more portion of asurgical device and one or more portion of a user's body (e.g. wheremeasured movement of a user body is used to control movement ofportion/s of the surgical device).

Exemplary Filtering

Optionally, in some embodiments, measured user movements and/or desireddevice movement mapped from user movements are filtered (e.g. to removeundesired and/or damaging movements) before the device is moved.Additionally or alternatively, in some embodiments, measured movement ofan input device is filtered, for example, before the device is movedaccording to the movement of the input device.

In some embodiments, movements are filtered to remove large movements.Where, for example, in some embodiments, large movements are movementstaking the device out of a defined working area (e.g. the abdomen)and/or are movements of more than a sum of the humerus and radius longaxis lengths. In some embodiments, movements are filtered to removesudden movements, For example, measured sudden movement is slowed and/orremoved. In some embodiments, tremors (e.g. fast small movements, e.g.movements which map to less than 20%, or 10%, or 5% of a radius longaxis length where the movement duration is less than 0.1 s or less than0.05 s or less than 0.01 s) are removed.

In some embodiments, movements are filtered to remove movement to adisallowed and/or damaging region. For example, in some embodiments, thedevice is prevented from moving into a disallowed region for example, anorgan. In some embodiments, a user attempting to move the device into adisallowed region receives an alarm and/or alert, e.g. through thedisplay, an audio alert, through force feedback of an avatar, throughfeedback (e.g. vibration and/or visual feedback (e.g. illuminated and/orflashing light)) of a device coupled to a user (e.g. the input deviceprovides feedback).

In some embodiments, disallowed regions are marked (e.g. by a user), forexample, before treatment (e.g. surgery) with the device commences.

For example, in some embodiments, a user delineates disallowed regionse.g. by instructing a surgical device to move to define edges of anallowed region and saving (e.g. in a memory) indications of the allowedregion. For example, in some embodiments, a user moves (e.g. using aninput device and/or measured user movement) a surgical device through aboundary (and/or to individual boundary points) where the boundaryline/s and/or points are saved.

In some embodiments, disallowed regions are identified in and/or markedon collected images, e.g. images collected by an imager (e.g. camera)inserted into the patient (e.g. with the surgical device) and/or imagescollected by additional imager/s (e.g. CT, MRI, ultrasound etc.). Insome embodiments, disallowed regions identified from images prior totreatment are mapped to images collected during treatment to generatedisallowed regions for filtering.

For example, in an exemplary embodiment, a user falls, user arm movementis filtered to remove the fall, and the surgical device pauses movement.

In some embodiments, an anatomical map for example, specified by a userand/or from imaging e.g. CT, MRI includes disallowed regions. In someembodiments, if a user attempts to move the surgical device to adisallowed region and/or moves the surgical device near to a disallowedregion, an alarm is initiated e.g. audio alarm, display alarm.

Exemplary System Modes

In some embodiments, a system (e.g. system 4250 FIG. 42 and/or system850 FIG. 8 and/or system 4550 FIG. 45) includes a plurality of operationmodes (also herein termed “states”).

FIG. 63A is a simplified schematic of exemplary system modes, accordingto some embodiments of the invention.

In some embodiments, a system includes a device movement control mode6302 where movement of an input object (e.g. input device and/ormeasured user body movement) controls movement of the surgical device.In some embodiments, (e.g. as described in more detail below) there ismore than one device movement state. In some embodiments, the system isin more than one mode concurrently (e.g. system is in more than onesurgical device movement control mode currently), e.g. in someembodiments a fine motion mode and a relative motion mode runconcurrently.

Exemplary surgical device movement control modes 6302 are describedbelow in more detail and include, for example, scaling mode/s 6304,electrosurgery modes 6306 where one or more portion of a surgical deviceis electrically charged, relative control mode/s 6308, timing mode/s,simultaneous control mode/s 6310, disallowed region/s mode/s 6312,mapping mode/s 6318 where input object movements are mapped and/orfiltered before being used to control movement of the surgical device.

In some embodiments, modes are selected by a user using one or more userinterface. In some embodiments, modes are selected by a user usinggestures (e.g. as described in more detail below).

In some embodiments, the system includes a pause mode 6320, wherecontrol of movement of the surgical device is paused. In someembodiments, pause mode 6304 is entered before selection of another modee.g. in some embodiments, a pause mode is entered before transferbetween and/or select and/or de-select surgical device movement controlmodes 6302.

In some embodiments, the system includes one or more resume mode 6322(e.g. as described in more detail below).

In some embodiments, the system includes one or more calibration mode,where for example, one or more portion of the system is calibratedand/or initialized.

In some embodiments, the system includes one or more camera controlmode, where 6330 for example, camera/s inserted with the surgical devicearms are controlled. In some embodiments, camera/s are controlled withone or more of the surgical device movement control modes 6302 e.g.camera/s position controlled with relative control mode/s and/or timingmodes, disallowed region mode/s etc. In some embodiments, camera controlmode/s 6330 include imaging modes e.g. zoom.

In some embodiments, the system includes modes for different userpostures, e.g. user is sitting or standing. Optionally, in someembodiments, gesture control is different in different user postures.

Exemplary Surgical Device Motion Control Modes

In some embodiments, a system includes a user motion control mode, wherea user controls movement of a surgical device by motion of the user'sbody. In some embodiments, a system includes an input device controlmode, where a user controls movement of a surgical device by moving aninput device. In some embodiments, a system includes a combined usermotion control and input device control mode where, for example,movement of one or more portion of a surgical device is controlled bymovement of an input device and one or more portion of the surgicaldevice is controlled by measured user body movement.

Exemplary Pause Mode

In some embodiments, there are various situations where device mimickingof user movement is paused and/or adjusted.

In some embodiments, a system includes a pause state, where, forexample, user body movement and/or movement of an input device does noteffect movement of the surgical device.

In some embodiments, a user selectively pauses surgical device mimickingof user movement and/or movement control by an input device (e.g.through a user interface). For example, if a user wants to take a break(e.g. due to muscle fatigue) and/or wants to change to a morecomfortable position, the user pauses mimicking of user movement and/ormovement control by an input device. In some embodiments, a user pausesthe device in order to (e.g. prior to) transfer to a different mode.

In some embodiments, a user selectively pauses one or more arm and thenselectively resumes control of one or more arm using user arm movement(and/or movement control by an input device). In some embodiments, auser controls more than two arms using pausing and selecting of arms.For example, a user controlling movement of two arms (e.g. using userarm movements), pauses one or both arms, and then selects two arms oneor more of which are optionally different from the initial two arms toresume movement.

In some embodiments, a user pauses a portion of a device, for example,in order to use device freedom of movement which is more than humanfreedom of movement (and/or to use device freedom of movement which ismore than the freedom of movement of an input device being used).

For example, in some embodiments, a user rotates a user segment untilthe user can no longer rotate the segment. The user then pauses thedevice, repositions the segment such that the user can continue rotatingthe segment, e.g. turning by the segment over.

For example, in some embodiments, a user pauses mimicking of user handmotion for rotation of a device hand through more degrees than possiblewith a user hand, e.g. to use the hand as a drill and/or screwdriver.

In some embodiments, a user pauses control with a user input device inorder to switch input devices (e.g. to use a different scaled inputdevice, e.g. to use an input device with a different number of limbs,for example upon inserting and/or removing a device tool and/or arm).

In some embodiments, a user pauses mimicking for one or more arm, forexample in order to switch between methods of control (e.g. as describedbelow).

Optionally, after resuming mimicking, the device and/or user arm isinitialized e.g. as described previously.

Exemplary Resume Mode

In some embodiments, after a surgical device is paused, there aredifferent types of resume mode, where movement control of the surgicaldevice is resumed.

For example, in some embodiments, upon entering a pause mode (and/orupon resumption of control when leaving a pause mode), a surgical devicearm and/or an input device arm move to a homing position (e.g.straighten); the system is in a homing mode.

For example, in some embodiments, for the system to move out of a pausemode, user body portion/s and/or input device portion/s are aligned tosurgical device limb/s.

For example, in some embodiments, after entering a pause mode, controlis resumed with relative control (e.g. as describe in the section below“Exemplary relative movement mode”). Optionally, to enter a relativecontrol mode after a pause mode, a relative movement mode is selectede.g. with a user interface and/or with a user gesture.

Exemplary Scaling Modes

In some embodiments, a system has different modes whereby a same sizeuser movement (measured user body movement and/or user movement of aninput device) results in different sized surgical device movements. Insome embodiments, a user transfers between different scale modes (whereuser movement is scaled by different amounts). For example, in someembodiments, a user performs large initial surgical movements (e.g.incisions) using a first scale mode and then transfers to a fine workmode where user movements are scaled down when performed by the surgicaldevice e.g. for suturing.

Exemplary Timing, Delay, Modes

In some embodiments, a system includes different modes for timing ofcontrol movements (e.g. measured movement of user device body portion/sand/or user movement of an input device) resulting in correspondingmovement of the surgical device.

In some embodiments, movement of the device (e.g. device arm) issubstantially at the same time as movement of the user arms and/or theinput device arms (e.g. with a delay of less than 2 seconds, or lessthan 1 second, or less than 0.5 seconds, or less than 0.1 seconds).

Alternatively, in some embodiments, movement of the device (e.g. devicearm) is delayed, for example, a user makes a movement, then optionallyauthorizing the movement for control of movement of the device.

In some embodiments, the device moves according to measurements of userjoints at the same speed as the user movement. Alternatively, in someembodiments, the device moves at a different speed (e.g. slower).

In some embodiments, a user selects an amount of delay and/or speedchange (e.g. through a user interface and/or with a user body gesture).

In some embodiments, a user performs control movement/s (e.g. by movingan input device and/or user body movement) to control movement of thesurgical device, but user control movement/s are stored and used tocontrol surgical device movement/s after a time delay.

For example, in an exemplary embodiment, a user records user controlmovements (e.g. in a memory, for example where the memory is accessibleby processor 4216, FIG. 42). After recording, in some embodiments, theuser (or a different user), initiates control of the surgical deviceusing the pre-recorded movement/s.

In some embodiments, a user controls movement of a surgical device byselecting from a list of pre-programmed movements and/or movementsequences.

In some embodiments, a user recording a sequence of control movementsselects (e.g. through a user interface) one or more break point withinthe sequence. In some embodiments, when a control movement sequenceincluding one or more break points is performed by a surgical device,the surgical device pauses at each break point (e.g. for a time periodand/or until receipt of a “resume movement” command from a user).

In some embodiments, a representation of a recorded movement and/ormovement sequence is displayed to a user controlling a surgical device(e.g. using an input device and/or with user body movement), forexample, assisting and/or instructing the user as to how to carry out aprocedure. In some embodiments, a representation of a deviation of usermovement/s from the recorded movement/s is displayed.

Exemplary Relative Movement Mode

Optionally, measured movement of one or more portion of the user's bodyand/or portion of an input device controls a portion of the surgicaldevice, without that portion of the surgical device having the sameposition as the measured portion/s, where surgical device position isthe orientation of segments relative to each other.

For example, in some embodiments, relative movement of one or moresegment is controlled by user movement (e.g. one or more portion of adevice arm is not initialized to a user arm position). For example, aportion of a device arm is bent (e.g. angle between device radius anddevice humerus is less than 180°), and the user arm is straight (anglebetween user radius and user humerus is 180°), but bending of the userradius with respect to the user humerus results in movement of thedevice radius with respect to the device humerus, e.g. in someembodiments, by the same number of degrees.

For example, in an exemplary embodiment, one or more device arm isoutstretched (e.g. to access a target within the body) for example withan angle of 90° or more between the humerus and support section, and(e.g. to provide the user with a comfortable working arm position) acorresponding user humerus segment is held downwards (e.g. at the usersides), for example with angles of less than 70° between the humerus andsupport section. Relative motion of user hand and/or radius and/or wristthen control movement of the device hand, radius and wrist respectively.

Exemplary Simultaneous Movement Mode

In some embodiments, measurement of user joints is of more than one limb(e.g. both user arms, an arm and a leg, two arms and one or more leg)simultaneously. In some embodiments, measurement of movement of morethan one input device limb is simultaneous.

Optionally, surgical device arms are then moved simultaneously, forexample according to the measurement. A potential advantage being theability of two or more device arms to work together, for example, tograsp a portion of tissue together, for example, to pass an object fromone hand tool to another etc.

In some embodiments, movement of a user arm and movement of a user handand/or tool avatar are measured simultaneously. Optionally, a surgicaldevice arm is moved and a device hand tool is actuated (e.g. opening,closing) simultaneously. A potential advantage user control of aposition and/or orientation of a tool and use of the tool simultaneouslye.g. similar to traditional surgery.

Exemplary Limit to Freedom of Movement Mode

In some embodiments, in a restricted freedom of movement mode, movementof an input device and/or surgical device is limited where, for example,rotation of one or more joint is restricted in direction and/or amountand/or flexion of one or more joint is restricted. In some embodiments,a user specifies the limits of freedom of movement of one or more joint.In some embodiments, a system includes a human freedom of movement mode,where freedom of movement of a portion of the surgical device and/orinput device is restricted to that of a corresponding body part (e.g. asurgical device arm and/or an input device arm is limited to mappedfreedom of movement of that of a human arm).

Generally, human freedom of movement (e.g. for arms) includes limits tothe angles of rotation and flexion of segments. Optionally, in someembodiments, the device is restricted to human freedom of movement e.g.during one or more control mode.

Exemplary Control of Transfer Between Modes and/or Mode Selection

In some embodiments, a system is transferred between modes and/or modesare selected through a user interface (e.g. button/s and/or touch screenand/or computer terminal and/or voice recognition unit etc.).

Alternatively, or additionally, in some embodiments, a user selects amode and/or transfers from one mode to another by performing a gesture,which is recognized by the system.

In some embodiments, a gesture is a single user movement, for example, auser raises a user leg, for example, a user transfers position (e.g.between sitting and standing). In some embodiments, a gesture is withone user body portion (e.g. a limb

-   -   e.g. raising of a user leg). In some embodiments, a gesture        involves movement and/or positioning of more than one body        portion, for example, an exemplary gesture being a user crossing        user legs.

In some embodiments, a gesture involves more than one sequentialmovement, for example, a user raising a user leg and then lowering theleg again. A further exemplary sequential gesture includes: Raising oneor the arms so that the humerus is at an angle of approximately 45° withrespect to the floor and then lowering the raised arm back down wards tothe hip (performing an angle of 90° with the same humerus). This gestureis, for example used to initiate and/or resume the movement of thelaparoscopic arms.

In some embodiments, the user changes mode (e.g. initiates a pause mode)by moving one or more body portion to a designated position and/or to adesignated object. For example, in some embodiments, a user pausescontrol of device arms by resting user arms on an arm-rest (e.g. adesignated arm rest).

Exemplary Initiation of Movement Control, Becoming an Operator

In some embodiments, the system stores one or more identifier for eachuser (e.g. in a memory, for example where the memory is accessible byprocessor e.g. processor 4216, FIG. 42). In some embodiments, a useridentifier includes user body dimension (e.g. a skeleton built fromrelative joint positions). In some embodiments, only users with storedand/or allowed skeletons are able to operate the device. For example, insome embodiments, a user enters a field of view of system cameras and/orperforms an initial gesture (e.g. initiation gesture), and the systemchecks if position of detected body portion/s match a stored skeletonbefore allowing the user to control the surgical device.

In some embodiments, a user which performs an initiation gesture becomesthe operator.

In some embodiments, a user becomes an operator upon detection of theuser sitting, e.g. at a control chair and/or sitting in a control zone.

FIG. 63B is a simplified schematic illustration of exemplary states andgestures for transition between states, according to some embodiments ofthe invention. In some embodiments, a user decides whether or not to sitor stand (e.g. upon starting to use the system and/or during use of thesystem) and the system is controllable by a user both in a seated and ina standing position.

In some embodiments, a system is in an initial “start state” before anoperator starts using a system. In some embodiments, an initial gesturetransfers the system from a “start state” into a state where the usercontrols the surgical device movements by an initial gesture. In someembodiments, depending on a user position (e.g. sitting or standing),different initial gestures transfer the user from the start state into acontrol state.

In some embodiments, for example, depending on whether the user isseated or standing, the user performs a different gesture to transfersystem states (e.g. from control into a pause mode). For example, insome embodiments (e.g. in a standing position lifting a leg transfersthe system state between modes. In some embodiments, when a user isseated, the same transfer is performed, for example, by a user crossingtheir legs. Potentially this assists ease of user control as crossinglegs while standing may be awkward as may be lifting a user leg whileseated.

In some embodiments, a user tailors and/or defines user controlmovements and/or gestures (e.g. according to user comfort and/or in thesituation where, for example a user is lacking a limb).

In some embodiments, depending on the gesture performed, the systemresumes using a different type of resume mode (e.g. different types ofresume mode as described above).

FIG. 63B shows exemplary transfer between resume and pause states, fortwo different resume states for different user positions (e.g. standingand sitting). In some embodiments, a user is able to change a userposition (e.g. between standing and sitting) while the system is pausedand/or when the system is controlled by user body movements (and/ormovement of an input device).

In some embodiments, a user moves a left leg to transfer between amotion control state and a pause state where a seated user, for examplelifts a left foot to transfer and a standing user, for example lifts aleft knee to transfer. For example, in some embodiments, a seated userrepetitively transfers to and from a pause mode and a motion controlmode by lifting and lowering a left foot repetitively. In someembodiments, moving the left leg transfers between pause state and amotion control state where resumption of control after the pause is froma homing position (homing mode).

In some embodiments, a user moves a right leg to transfer between amotion control state and a pause state where a seated user, for examplelifts a right foot to transfer and a standing user, for example lifts aright knee to transfer. In some embodiments, moving the right legtransfers between pause state and a motion control state where controlresumes without the surgical device moving during and/or at initiationof entry into the pause mode.

Exemplary Determining of Gestures

In some embodiments, at one or more point in user use of a system, forexample, upon a user starting use of the system, upon a user changingposition (e.g. from seated to standing) one or more position of one ormore body part is measured and, in some embodiments, recorded.

In some embodiments, gesture recognition uses recorded user body partposition/s (and/or stored average position for the body part). Forexample, in an exemplary embodiment, when a user sits down, the heightof one or more user foot is measured and/or recorded (e.g. in a memory).In some embodiments, a recorded foot height is used to determine whethera measured foot height and/or change in foot height relates to whetheran operator has performed a “raise foot” gesture. In a motion controlmode, for example, when a leg and/or foot is used to control motion of aportion of a surgical device (e.g. a device limb), a pre-recorded seatedfoot position is used to determine if a user's foot has moved and/or isused to quantify amount of movement of the user's foot.

Exemplary Control of Surgical Device Hand Tools

For example, as described above (e.g. in the section titled “Exemplaryuser interface/s”), a user controls a hand tool (also herein termed endeffecter) using a user interface.

In some embodiments, a user controls a hand tool by moving portion/s ofan input device, where the portions correspond to portion/s of the handtool.

Alternatively, or additionally, in some embodiments, one or more handtool (also herein termed “end effecter”) is controlled by measuredmovement of user hand/s. In some embodiments, actuation (e.g. openingand closing) of a hand tool is controlled by relative position of auser's fingers and/or thumb. In some embodiments, closing of a tool iswhen two or more points and/or surfaces of the tool are brought closertogether (e.g. flat surfaces of scissor blades are slid into contactand/or close proximity). In some embodiments, opening of a tool is whentwo or more points and/or surfaces of the tool are moved further apart.

In some embodiments, a user controls a position and/or movement of ahand tool, (e.g. by positioning the distal end of the radius using userarm movements, e.g. as described above) and simultaneously actuates thehand tool (e.g. controls opening and closing of a hand tool).

In an exemplary embodiment, a hand tool is closed when distal ends of auser thumb and finger/s are brought together and/or opened when distalends of user thumb and finger/s are moved apart.

FIG. 64A is a simplified schematic of an open user hand, according tosome embodiments of the invention. FIG. 64B is a simplified schematic ofa portion of a device arm including a hand tool where the hand tool isin an open position, according to some embodiments of the invention.

FIG. 64C is a simplified schematic of a closed user hand, according tosome embodiments of the invention. FIG. 64D is a simplified schematic ofa portion of a device arm including a hand tool where the hand tool isin a closed position, according to some embodiments of the invention. Insome embodiments, transition of the device hand tool from the openposition illustrated in FIG. 64B to the position illustrated in FIG. 64Dis achieved by movement of the user's hand from the position illustratedin FIG. 64A to the user hand position illustrated in FIG. 64B.

In some embodiments, rotation of a user hand is measured by detectingthe relative position of distal ends of user thumb and/or one or morefingers. In some embodiments, the device hand rotation about a hand longaxis rotation is controlled by measured mapped user hand rotation.

In some embodiments, a user performs a “short-cut” motion to initiate amovement or sequence of device arm and/or hand movements (e.g. agesture), e.g. movements to tie a suture knot, repetitive rotation forscrewing and/or drilling. FIG. 65 is a series of photographicillustrations showing exemplary control of a device hand using measureduser hand position, according to some embodiments of the invention. Insome embodiments, position and/or movement of user fingertips and thumbis captured using motion capture technology, where captured positionsare illustrated as white circles on image A.

In some embodiments, mapped measured orientation and/or movement of atool avatar held by the user controls the orientation and/or movement ofa device hand tool. In some embodiments, a tool avatar is a miniaturemodel of the user hand tool. In some embodiments, a tool avatar includesportions which the user manipulates with the hand grasping the avatar,to actuate the tool avatar: For example, in some embodiments, a scissorshand tool is controlled by a user holding a pair of scissors.

For example, in some embodiments, a user holds a pair of scissors themotion and/or opening and closing of which is mimicked by a devicescissors hand tool (e.g. using motion capture of one or more part of thescissors). In some embodiments, a hand tool avatar includes markersand/or is coated, at least partially, in reflective material, forexample, to aid motion capture.

In some embodiments, the hand tool avatar is part of a device avatar, asdescribed above.

Optionally, in some embodiments, the avatar provides force feedback oftissue to the user. For example, a scissors avatar resists opening andclosing corresponding to the resistance of tissue being cut by devicehand tool scissors. For example, a scissors or gripper performingelectrosurgery.

In some embodiments, a tool avatar provides force feedback to a user,for example providing the user information as to device tool conditions.For example, the device includes one or more pressure sensor, the datafrom which is used to provide feedback, e.g. through one or moreactuator, to a user. For example, in an exemplary embodiment, a scissorsavatar provides resistance to a user opening and closing of the scissorsreflecting the resistance of tissue that a corresponding device scissorshand tool is cutting.

General

As used herein the term “about” refers to ±20%.

The terms “comprises”, “comprising”, “includes”, “including”, “having”and their conjugates mean “including but not limited to”.

The term “consisting of” means “including and limited to”.

The term “consisting essentially of” means that the composition, methodor structure may include additional ingredients, steps and/or parts, butonly if the additional ingredients, steps and/or parts do not materiallyalter the basic and novel characteristics of the claimed composition,method or structure.

As used herein, the singular form “a”, “an” and “the” include pluralreferences unless the context clearly dictates otherwise. For example,the term “a compound” or “at least one compound” may include a pluralityof compounds, including mixtures thereof.

Throughout this application, various embodiments of this invention maybe presented in a range format. It should be understood that thedescription in range format is merely for convenience and brevity andshould not be construed as an inflexible limitation on the scope of theinvention. Accordingly, the description of a range should be consideredto have specifically disclosed all the possible sub-ranges as well asindividual numerical values within that range. For example, descriptionof a range such as from 1 to 6 should be considered to have specificallydisclosed sub-ranges such as from 1 to 3, from 1 to 4, from 1 to 5, from2 to 4, from 2 to 6, from 3 to 6 etc., as well as individual numberswithin that range, for example, 1, 2, 3, 4, 5, and 6. This appliesregardless of the breadth of the range.

Whenever a numerical range is indicated herein, it is meant to includeany cited numeral (fractional or integral) within the indicated range.The phrases “ranging/ranges between” a first indicate number and asecond indicate number and “ranging/ranges from” a first indicate number“to” a second indicate number are used herein interchangeably and aremeant to include the first and second indicated numbers and all thefractional and integral numerals therebetween.

As used herein the term “method” refers to manners, means, techniquesand procedures for accomplishing a given task including, but not limitedto, those manners, means, techniques and procedures either known to, orreadily developed from known manners, means, techniques and proceduresby practitioners of the chemical, pharmacological, biological,biochemical and medical arts.

As used herein, the term “treating” includes abrogating, substantiallyinhibiting, slowing or reversing the progression of a condition,substantially ameliorating clinical or aesthetical symptoms of acondition or substantially preventing the appearance of clinical oraesthetical symptoms of a condition.

It is appreciated that certain features of the invention, which are, forclarity, described in the context of separate embodiments, may also beprovided in combination in a single embodiment. Conversely, variousfeatures of the invention, which are, for brevity, described in thecontext of a single embodiment, may also be provided separately or inany suitable subcombination or as suitable in any other describedembodiment of the invention. Certain features described in the contextof various embodiments are not to be considered essential features ofthose embodiments, unless the embodiment is inoperative without thoseelements.

Although the invention has been described in conjunction with specificembodiments thereof, it is evident that many alternatives, modificationsand variations will be apparent to those skilled in the art.Accordingly, it is intended to embrace all such alternatives,modifications and variations that fall within the spirit and broad scopeof the appended claims.

All publications, patents and patent applications mentioned in thisspecification are herein incorporated in their entirety by referenceinto the specification, to the same extent as if each individualpublication, patent or patent application was specifically andindividually indicated to be incorporated herein by reference. Inaddition, citation or identification of any reference in thisapplication shall not be construed as an admission that such referenceis available as prior art to the present invention. To the extent thatsection headings are used, they should not be construed as necessarilylimiting.

What is claimed is:
 1. A method of jointed mechanism movement,comprising: measuring user limb movements and a user finger movementssimultaneously; mapping said measured user limb movements to a devicelimb and said measured user finger movements to a device limb tool;moving said device limb according to said mapped movements; actuatingsaid device limb tool according to said user finger movements; whereinsaid moving and said actuating are simultaneous.